Codeine tops list of pharmaceutical drugs reported missing in Manitoba

Among thousands of potentially harmful pills and capsules reported missing each year to Health Canada, codeine is the pharmaceutical drug reported missing in the greatest quantities in Manitoba.

Under the Controlled Drugs and Substances Act, a report must be made to Health Canada if pharmaceuticals in the "controlled drugs" categorygo missing. That category includeshighly addictive opioids such as codeine, oxycodone, hydromorphone and others.

Between January 2012 and September 2017, some 8.7 million units including pills, tablets, capsules, patches, and suppositories went missing from pharmacies and hospitalsor in transport, according to a CBC News analysis of Health Canada's data.

That includedclose to 350,000 units in Manitoba.

Most of the losses in Manitoba were reported by pharmacies but the data also includes loss reports from hospitals and transportation companies.

"I am a little bit startled at the amounts, the quantities of medication that are going missing," said Sheri Fandrey, knowledge exchange lead at the Addictions Foundation of Manitoba.

The reported reasons for the losses range from criminal actssuch as armed robbery, break-ins andtheftto other factors such as loss or breakage in transit, breakage on site, pilferage, spillage, manufacturer's shortagesand the largest category,"unexplained" loss.

'Where are thesemedsgoing?'

Experts say that when drugs go missing, they often end up being sold to people with addictions who are unable to get a prescription.

"All of the medications on the list have a street value so I would have to suspect that at least a portion, possibly even a majority of the medication, are intended to be sold on the street," said Fandrey.

"In terms of my passion for prevention, we need to find a way to prevent large losses like this from happening. I can understand small amounts where a package falls off the truck, but this is a lot of packages falling of the truck."

She said the fact the missing drugs were reported to Health Canada is a sign the country has good controls over the transportation, storage and distribution of controlled drugs. But it also raises questions.

"Where are these meds going? Who is accessing them? Are they part of the street supply of illicit prescription medications?"

The data includes more than 4,000 reports of missing drugs in Manitoba, the majority in small quantities and often as few as one or two tablets.

But in some cases, large quantities were reported missing: 18,232 codeine tablets in the form of Tylenol No. 1 went missing in an "unexplained loss" in 2013. In 2016, 20,000 ephedrine tablets were reported lost in transit, and another 20,000 ephedrine tablets were lost in transit in 2013.

In 2015, a pharmacy reported 5,903 oxycodone tablets missing in an unexplained loss.

110K codeine pills reported missing

"Unexplained losses include inventory discrepancies that cannot be explained, poor record keeping of inventory and lack of inventory controls, and lack of reconciliation of inventory," a Health Canada spokesperson said in an email.

All losses of controlled drugs are required to be reported to Health Canada within 10 days of being discovered, and in the case of unexplained losses, the report must be amended if the explanation is later determined.

In Manitoba, the data shows the drug reported to Health Canada as missing in the greatest quantities by far is codeine, with nearly 110,000 pills reported missing. That was followed by oxycodone, ephedrine, hydromorphoneand lorazepam.

"Codeine is one of the weakest of the opioid types of drugs," Fandrey explained, "which means that people need to take very large doses in order to feel the affects. That carries with it a risk, the fact that you are taking very large amounts," she said.

The problem Fandrey points to is that in pharmaceutical products, codeine is often mixed with other drugs such as acetaminophen.

"Acetaminophen is harmfulit is not addictive but it can cause serious harm to your liver. So in the pursuit of a high from a drug like codeine you are also putting yourself at risk to serious damage to your liver," Fandrey said.

• Opioid death toll in Canada nearly 4,000 last year, new data show
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"Oxycodone and hydromorphone are very potent abusable opiate-type drugs. The risk of addiction is strong for those drugs depending on people's circumstances but certainly the potential for abuse is very strong," said Fandrey.

"The opioids, we know that we are having a crisis. These medications can either be the drug that people are primarily using, or it could fill the gap when they're not able to find their drug of choice, like fentanyl."

High number might be result of 'diligent reporting'

Sometimes the addicted person is someone working in the health professions, such as a pharmacist.

The College of Pharmacists of Manitoba regulates the profession, which has more than 1,500 practising members, and oversees the more than 400 pharmacies that employ them: 398 located in the community and 36 in hospitals.

Routine inspections are part of the college's efforts to try to ensure pharmacists are properly tracking inventory.

"We're working towards improving accountability around narcotics and controlled drugs and ensuring that pharmacists have measures in place in their pharmacies to prevent loss, theft," said registrar Susan Lessard-Friesen.

She said the high number of missing drug reports "might be just more diligent reporting by pharmacies."

Health Canada inspects pharmacies under a program launched in 2015 called the Community Pharmacy Inspection Program.

It includes oversight of loss and theft reports, and security measures in place at pharmacies. Of the 300 inspections across Canada in the most recent year, the program's latest annual report says 12 Manitoba pharmacies have been inspected so far.

Since launching theinspection program, Health Canada "has observed a significant increase of reports of loss and theft in pharmacies around the country," spokesperson Maryse Durette said in an email.

The increase was attributed to Health Canada's outreach with professional regulatory colleges and industry groups.

The College of Pharmacists recently disciplined at least two pharmacists with addiction issues for taking controlled drugs out of inventory without authorization, according to discipline reports published in 2017.

Both cases involved pharmacists who were participating in Manitoba Pharmacists-At-Risk, a program designed to help pharmacists with a variety of personal issues, including addiction.

CBC'sVik Adhopia explains what might be happening to the missing medications:

Where did millions of missing opioid doses go?

6 years ago

Duration 1:48

Every year, hundreds of thousands of controlled drugs (mostly opioids) that were supposed to end up on pharmacy shelves are reported missing to Health Canada and that number is on the rise. Vik Adhopia explains what might be going on.

• More stories from CBC Manitoba's investigative I-Team

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