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10/20/2003

Pharmacy Boards Struggle With Internal Theft in Pharmacies

Kate Traynor

Jerry Moore, executive director of the Alabama State Board of Pharmacy, recently shared his insights on the state's efforts to prevent people who obtain jobs as pharmacy technicians from diverting hydrocodone and other drugs.

During the National Association of Boards of Pharmacy (NABP) 2003 Fall Legislative Conference in Washington, D.C., Moore said that drug diversion in general is a major concern of his state board of pharmacy.

"We're seeing a tremendous amount of diversion," Moore told his audience. In fact, he said, "Alabama leads the nation in hydrocodone diversion, and that's not something I'm proud of."

Although the state pharmacy board has long held disciplinary power over pharmacists, other people working in the pharmacy were classified until recently as "ancillary personnel." When these employees diverted drugs, Moore said, the board of pharmacy "had no jurisdiction" to discipline them.

Alabama's 1997 decision to require pharmacy technicians to register with the board of pharmacy set standards for the profession and was intended, in part, to make it harder for would-be diverters to work in pharmacies, Moore said. Once registered, Moore said, a technician comes under the board's authority and can be subject to disciplinary action.

But registration of these formerly ancillary personnel has not put an end to drug diversion.

"We're seeing a lot of people who are being registered as technicians who are diverting drugs," Moore said. "We've even come to the conclusion that maybe there might be a conspiracy, a wave of people who are hiring these people and paying their registration fee just to get them into the pharmacy to divert drugs."

Once in the pharmacy, these people, who apparently had no intention of working as pharmacy technicians at all, "take the hydrocodone, or whatever, and then they leave," never to be seen again at the pharmacy, Moore said.

Registration requires the payment of a $20 annual fee and the submission of a photograph and a completed application. According to the state's pharmacy practice act, the pharmacy board cannot register applicants who have been convicted of drug-related offenses, violated the state's controlled substances act, or shown other signs of lacking "good moral character."

About 15,000 people have been registered as a pharmacy technician in the state, Moore said, and just over half of those are currently registered. Registrations must be renewed annually, and no one may work as a pharmacy technician in the state without a current registration. Last year, the pharmacy board set a minimum age—17 years—for pharmacy technicians and added a requirement that they complete three hours of continuing education each year.

Drug diversion does not always involve controlled substances. Sometimes, he said, technicians "are just giving their friends medicine, and they just don't charge for it."

The board of pharmacy takes these cases seriously, Moore said. "If they're stealing whatever, whether it's Viagra, or whether it's Celebrex, it doesn't make any difference," he cautioned. "Tomorrow, it may be a controlled substance, so you have to take action."

Moore said that 20 pharmacy technicians in Alabama were caught diverting controlled substances or other drugs last year and had their registrations revoked. By September of this year, when Moore spoke at the NABP conference, 16 technicians had already had their registrations revoked for diverting drugs.

About half of all states now register or license pharmacy technicians. Charles Myers, group vice president of Professional Development and Member Services for ASHP, said that the Society "has no data on the relationship between diversion and registration" of technicians.

"But it is understandable," he added, "that boards of pharmacy would want to act in all possible ways to preclude diversion."

In Ohio, pharmacy technicians are neither registered nor licensed by the state board of pharmacy (for an explanation of the differences between licensure and registration, see ASHP's "White Paper on Pharmacy Technicians 2002: Needed Changes Can No Longer Wait," (PDF) published in the January 1, 2003, issue of AJHP).

William T. Winsley, executive director of the Ohio State Board of Pharmacy, said that his organization is considered a law enforcement agency and, as such, has the authority to address drug diversion by pharmacy technicians.

"We have a way of dealing with technicians that many other states do not," he explained.

Tim Benedict, assistant executive director of the Ohio State Board of Pharmacy, said that drug diversion is a major problem in the state.

"It's consuming the majority of our investigators' time," he said, adding that pharmaceuticals are becoming an ever-larger proportion of illegal drug trafficking overall.

Benedict said that pharmaceuticals make their way onto the street through "bad scripts being passed, bad doctors writing them, breaking and entering, armed robberies—just about any way you can think."

He added that the state has had "a lot of internal theft going on in the last few years" by pharmacists, technicians, and others who work in the pharmacy. Benedict estimated that about five or six recent diversion cases have involved pharmacy technicians stealing more than 50,000 dosage units of controlled substances.

Winsley advised pharmacists who are concerned about internal theft to "pay attention to their ordering and their distribution" of medications, especially when ordering is delegated to a non-pharmacist. Large orders for drugs that are not dispensed frequently could indicate a plan to divert the excess stock.

But all too often, Winslow said, pharmacists "pay no attention to what's coming in the door."

Moore, during the NABP event, described some of the devious ways that people who intend to divert drugs have used to gain access to pharmacies in the state. His advice to pharmacists: "Don't let people into the pharmacy if you don't know who they are."