Pharmaceutical Supply Chain Thefts

Pharmaceutical Supply Chain Thefts – CA State Board of Pharmacy – Virginia Herold, Executive Officer – Aug 2013

This text from a PowerPoint Slide Presentation gives a view into a high impact, but little-discussed, type of drug diversion: from the supply chain where huge amounts of pills are shipped and stored in various warehouses.

Changes in Controlled Substance Loss Profile

2000 – TEN YEARS AGO

• manufacturing losses rare
• wholesale losses rare, usually losses within the wholesale premises
• pharmacy losses – varied and small some self use.

2010 – TODAY

Manufacturing 

• Eli Lily Warehouse – $75 million
• Eli Lily truck $37 million
• Teva truck – $11.8 million
• Novo Novodisk truck – $11 million
• Astellas truck – $10 million
• Unknown company – $8 million
• GSK Warehouse – $5 million
• Exel Distribution Center – $3 million
• Dey Pharmacueticals 2 trucks – $2 million each

2013 Wholesaling 

• Internal losses
• In-Transit losses
• Manufacturer to wholesaler – concealed losses in large shipment
• Wholesaler to pharmacy

Theft from

• wholesaler’s delivery vehicle and drug contents
• contract delivery drivers
• contract mail delivery services (UPS, Fed Ex)

2013 Pharmacy

• Total number of pharmacies reporting losses has increased
• Total amount of controlled substances lost, increased

Individuals stealing from pharmacy

• Pharmacy technicians, clerks, delivery drivers steal to sell and or self use
• Pharmacists usually steal to self use
• Employees knowing someone or affiliated themselves with gangs

Stealing becoming a supplement to regular income

Specific drugs lost more frequently

• Vicodin products
• Oxycontin
• Alprazolam
• Promethazine & Codeine

BUT:

Legitimate pain patients must receive prompt, appropriate treatment to meet their pain needs without discrimination.

It is the pharmacist’s professional responsibility to make appropriate decisions regarding dispensing of pain medication for a legitimate medical need.

Pharmacist-In-Charge must review invoices for dangerous drugs received by pharmacy.

• 100,000 tablets of Vicodin stolen by ordering technician from a children’s hospital and no one at the hospital knew until police arrested trusted employee. Did not normally stock Vicodin tabs.
• 450,000 tablets of generic Vicodin stolen from a retail pharmacy by trusted employee. Pharmacy had no idea drugs were missing
• 55,000 HPAP products stolen in 14 days from hospital pharmacy

How to Determine if You Have a Loss

Perpetual inventory – count and check inventory

If no perpetual —as soon as suspect a loss, inventory/count the drugs in question – Date and time your inventory

I’m shocked that a perpetual running inventory of controlled drugs isn’t absolutely required. When pain patients are called in for a “pill count”(as stipulated in their “opioid contract”), they are forced to account for every single pill. Yet, in places where thousands of pills are stored, the record-keeping seems much less stringent.

To be effective, inventory should be more rigorously monitored where millions of pills are being shipped from one business to another and thousands can disappear without notice.