Nova Scotia to beef up drug monitoring after Dr. Sarah Jones allegations

Changes are coming to strengthen Nova Scotia'sprescription monitoring program in the wake of anallegedopioid pill trafficking scheme by Dr. Sarah Jones.

The province'sPrescription Monitoring Program (PMP) repeatedly flagged issues with Jones as far back as six years ago, CBC learned. She was onlycriminally chargedby police inBridgewater this year, who alleged the 35-year-old trafficked 50,000 Oxyneo and oxycodonepills.

• Nova Scotia drug monitoring program 'not working the way it was intended'

Nova Scotia Health MinisterLeo Glavine says the "lag time" between incidentsand follow-upneeds to be shortened.

"Not waiting for a lengthy period of time to really determine that yeah, this is a trend with this doctor or with this patient," Glavine told CBC News.

"I believe there has to be quicker intervention."

'Real teeth and real measures'

Glavinewould not speak specifically about the Jones case, but said generally, when the program catches suspicious activity, police should be called.

"We are heading for stronger legislation associated with this program that will provide real teeth and real measures to reach the desired goal of catching those who are doing inappropriate prescribing," Glavine said.

The current Prescription Monitoring Act says if the administrator of the program, Medavie Blue Cross, has reasonable grounds to believe a crime wascommitted,they"may" pass the tipover to police.

The province plansto change the law in order to boost the involvement oflaw enforcement, Glavine said.

"One of those recommendations that will definitely come forward is that PMP will have the legislative ability to call in the policeand do the required investigation as a result of the data that they now see as being red-flagged," hesaid.

• Dr. Sarah Jones under scrutiny 6 years before drug trafficking charges

Auditor general flagged 'significant weaknesses'

While PMP was flagging issues with Dr. Jones, the program itself was under the microscope of the Nova Scotia Auditor General's office.

The auditor general found "significant weaknesses" in the program that could allow abuse or misuse of prescription drugs to go undetected.

The review done in 2012 made 17 recommendations, but after three years, only 13 were followed.

• Read the full 2012 auditor general report onNova ScotiaPrescription Monitoring Program

"When we reported last year, we were quite clear that we were not happy with the results," Auditor General Michael Pickup said Thursday.

He said he's also concerned that threeoutstanding issues in particularare "core" to the program's ability to catch and react to suspected opioid over-prescribing:

• Use technology to trigger or target the right prescribing issues, so the data isn't overwhelming
• Follow up the prescribing issuesand document responses
• Have a quality assurance process to ensure monitoring is working.

Monitoring program 'disappointed'

The programresponded to the auditor general's review with criticism.

"While the board agrees with the individual recommendations, it is disappointed with the overall tone of the report," the program's administration said in comments to the auditor general.

Pickup said he doesn't keep "books with good and bad," but notedsomegovernment programs followhis recommendations. Others provide understandable reasons why they aren't able to, he said.

'We didn't think that was reasonable'

But PMP falls in a different category, Pickup said.

"I have a bucket that I would say are those that aren't doing as well, that frankly I can't understand, and think they should be implemented," Pickup said.

"It wasn't done and we didn't think that was reasonable."

Pickup said he will be reporting to the Public Accounts Committee of the legislature on April 27 about whether PMP has followed his advice four years after the report.

Following deadlines is important for accountability because the longer a weakness drags on,"the risk to abuse or the potential for something to go wrong here continues, so that's really what it's about," he said.

Quality review ordered

In the meantime, Glavine has ordered a quality review of how PMP handled the Jones case.

He'sexpecting within a few weeks to name the reviewer, likely someone from Ontario withexpertise in monitoring programs, he said.

But what's already become clear is that program staff are overwhelmed with data, he said,coming out of "hundreds of thousands of transactions." He said they need tozero in on the cases of concern.

"We need much more ease and much quicker alerting when there is some pattern emerging," Glavine said.

"Do we have enough people with those analytical skills?"

$500,000 on the street

The case is worryingthe presidentof Doctors Nova Scotia, the association that represents doctors across the province. Dr. David Milne said ithighlights a larger problem: the prevalence of opioid over-prescribing, diversion of the pillsand the harm caused.

He said oxy pills normally are sold on the street for about$10 each, so he said he calculates 50,000 pills as beingworth around $500,000.

"Diversion of that amount of medication represents a significant street value and a significant law problem, as well," Milne said.