Drug Diversion and Abuse: Diversion in the Pharmacy

When diversion happens in your pharmacy, it is important to know the appropriate steps to take and the appropriate agencies to notify.

A recent post on our list server from a pharmacist in West Virginia indicated that he had just discovered a theft in his pharmacy. Apparently, he noticed sometime after a delivery that many of his CII prescription bottles had been slit on the side, with a quantity of pills missing from each bottle.

Varying strengths of oxycodone and oxymorphone had been removed from the bottles prior to their delivery. A check with at least one other pharmacy near his with the same delivery driver revealed CII bottles with the same slit just below the foil seal. The pharmacist immediately notified the wholesaler, but wanted to know what he should do next.

In this situation, you should first call your local law enforcement agency. Undoubtedly, this is the agency that will need to complete the criminal investigation and ultimately charge someone in criminal court with this crime. This scenario is potentially solvable, but time is of the essence in reporting to law enforcement, especially if the delivery person is still out on the job. Hopefully your law enforcement agency will recognize the severity and respond quickly to your report. Catching this delivery driver before he leaves for the day would be the optimum advantage for law enforcement.

In addition, you will need to report the loss/theft to the regulatory arm of the Drug Enforcement Administration (DEA) Office of Diversion Control right away, through either a facsimile or telephone call to your nearest DEA Diversion field office. If you report this initially by phone, make sure you get the full name of the individual on the other end of the line, and write it down! You will then need to fill out DEA Form 106 to give the DEA officials the complete list of the controlled substances missing. You can actually fill out this form online at www.deadiversion.usdoj.gov/21cfr_reports/theft/index.html. You will need to tell them what law enforcement agency you contacted to report the theft.

In some states, it will also be necessary that you contact your state regulatory agency with some of the same information you gave law enforcement and DEA Diversion. The agency you will need to contact may vary, but it likely is your state pharmacy board or some other combined health professional board that requires the reporting of the loss or theft of pharmaceuticals. In some states, like Ohio, they require reporting of all lost or stolen pharmaceuticals, controlled or noncontrolled states. Know your state regulations, and make sure you comply with them.

In this situation, an alert pharmacist noticed the diversion by the delivery driver by examining the bottles and starting to take action. Make sure you give your bottles a quick examination when they are delivered, and do not hesitate to look further if something draws your suspicion. Finding this kind of theft in your pharmacy when the bottles are delivered, instead of days or weeks later, can definitely be the difference in a successful investigation— if not reported right away, police may contemplate a number of suspects, which includes anyone who worked in your pharmacy over the time period after delivery.

This scenario is virtually impossible to prevent, but you can be better prepared if it happens to you by getting to know your local law enforcement officer. Whether that individual is the uniformed officer or the investigator who helps you with other diversion issues, get to know him or her. Regulatory agencies (DEA Diversion, state boards) have their role, but usually will have very little to do with the actual active investigation, because they rarely have law enforcement powers. Therefore, knowing who to call within your police or sheriff’s office or state police agency will likely make this report much easier with a better chance of it being solved. â– 

John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at burke@choice.net, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.