Pharmacy paid addict kickback for prescription: hidden camera
Downtown Eastside doctors complained to authorities about practice months ago
Some pharmacists in Vancouver's Downtown Eastside routinely pay cash to drug addicts for filling their prescriptions, a CBC hidden-camera investigation has found.
The practice was revealed after several doctors complained that pharmacies were giving $10 a week or more to clients for each prescription filled if the drugs were dispensed daily. The daily prescription entitles the pharmacist to a daily dispensing fee, rather than a single fee for a long-term prescription.
In the drug-ravaged neighbourhood, $10 cash buys a "rock" of crack cocaine.
"All of a sudden we had a lot more [illegal-drug] dealers hanging around our clinic," said Dr. Helen Weiss of the Vancouver Native Health Clinic (VNHC) on East Hastings Street. "The cash deal is available to everyone who goes to certain pharmacies."
"Now you have patients being very demanding and trying to be very directive as to what they should get in terms of their prescriptions," said Dr. David Tu. "There is a lot of frustration amongst the doctors."
The more prescriptions a pharmacy fills for customers covered by PharmaCare — the provincial agency that uses taxpayers' money to help eligible British Columbia residents cover the cost of eligible prescription drugs — the more money it can charge.
Most of the addicts in the Downtown Eastside are covered by the plan.
The province pays pharmacies $8.60 each time they dispense a drug, even if it's just a single pill handed out daily. On top of that, the pharmacies get an additional $7.70 per daily dose for dispensing methadone and supervising the patient as they drink it.
The doctors at VNHC believe that if the daily dispensing were eliminated, pharmacists would have no incentive to encourage daily prescriptions or pay kickbacks.
"It's a waste of money, certainly — in the area of hundreds of thousands of dollars that could be so much better spent," Tu said.
Recently, CBC placed a hidden camera on an addict who needed a prescription filled for Tylenol 3. He went into AYC Pharmacy, a few doors down from the VNHC, and asked the manager, Manji Farbeh, for a $10 payback.
"For this we don't give you $10 — $5, just $5," Farbeh replied.
She explained she wouldn't pay $10 because the addict's prescription was only good for a week.
The addict, whom CBC News has agreed not to name, replied: "Five? Come on. How am I supposed to get a [cocaine] rock for five bucks?"
Farbeh laughed, then a pharmacist handed the addict a $5 bill. Outside the pharmacy, other customers told the addict they have been paid more.
"There was one time when I got my methadone they gave $30," said one female customer who was recorded by the hidden camera. A male customer added: "Ten bucks a week. That and 20 bucks every two weeks for my methadone."
Bernadette Murphy, spokeswoman for B.C.'s Ministry of Health, said it is a violation of the pharmacist's contract with government to pay customers for prescriptions.
"There are rules set out in the British Columbia PharmaCare Pharmacy Participation Agreement which basically says that no incentives shall be offered as an inducement to secure prescription orders," Murphy wrote in an e-mail.
CBC News requested an interview with the owner of AYC Pharmacy, where the addict with the hidden camera was given a cash incentive.
Nikhil Buhecha's lawyer responded by letter, indicating he was willing to participate under certain conditions. Buhecha did not respond to subsequent phone calls. Buhecha also owns Abbott Renuka Pharmacy, which is also in Vancouver's Downtown Eastside.
CBC News obtained prescription records for a patient who gets nine different pills dispensed daily at Buhecha's pharmacies. From his business alone, the records show, the pharmacy could charge the province almost $2,400 a month in dispensing fees. At the $10-a-week cash rate per prescription, the cash payback to the customer could reach $400 a month.
The doctors at VNHC said they've seen a sharp increase in patients asking for unnecessary and perhaps dangerous drugs.
"People come in and they are on multiple prescriptions," Weiss said. "People are trying to get on methadone who actually are not narcotic addicts simply because they can get a small [cash] incentive and then perhaps sell it on the street."
Weiss said she watched as one of her patients was screamed at by her boyfriend because she didn't get a prescription he could cash in.
Tu said a patient of his was given a dangerously high amount of methadone after she switched to a cash-paying pharmacy.
"They double-dosed her," Tu said. "She could have died, and we had to watch her for 24 hours."
CBC News watched outside AYC Pharmacy early one morning as dozens of patients lined up to get their methadone. Several walked out with a Styrofoam cup full of liquid before drinking from it. Very few of them drank from their cups in front of the pharmacist.
Apparent rule violation
That is also an apparent violation of rules governing pharmacists, which state they are supposed to make sure patients drink all their methadone before leaving the premises.
Guidelines posted at the College of Pharmacists of B.C. website read: "After the patient drinks the methadone, a short conversation is required to ensure that the methadone has been swallowed. Confirmation … is necessary as some patients may try to keep the methadone in their mouth until they can spit it into a container."
Doreen Littlejohn, a nurse with the nearby Native Health Society, confirmed that 10 patients surveyed recently said they often leave AYC with a full Styrofoam cup of methadone in hand.
"I asked everyone who came in that day if they are able to take their methadone with them, and they all said yes," Littlejohn said.
"There is a lot of methadone for sale on the street," Weiss said, "and it's because people manage to walk out with it. That methadone has high street value and you sell it to someone — a very powerful narcotic — and they don't know what they are doing and there can be overdoses."
The doctors at VNHC wrote letters of complaint to the Ministry of Health and the B.C. College of Pharmacists. Weiss said PharmaCare's director of pharmaceutical services, Bill Mercer, assured her in January of 2008 that tough action would be taken and asked her not to go to the media with her concerns.
"The people I spoke with genuinely seem concerned but I think they are very limited in what they can do," Weiss said, "partly because our patients have no credibility."
7 months of silence
The VNHC doctors said they have heard nothing from the authorities in the seven months since they lodged their complaints.
"They need to investigate," Tu said. "They need to take these allegations seriously because the system is going to crumble if they don't."
Tu is especially worried the competitive pressure from pharmacies that pay kickbacks will drive those that don't out of business.
"Pharmacists are our partners," he said. "They are an essential part of the health-care system. We rely on them so heavily and then to have them be people that are behaving unethically according to their own pharmacy code, and in such ways that I feel that I can't trust them — that's what hurts. That's what this is about, I think."
"We are very concerned about this," B.C. Minister of Health George Abbott said. "If the practices as alleged are occurring as alleged then obviously there's a range of remedies that we can employ, and that range of remedies would certainly include an end or termination of opportunity for the pharmacy in question to distribute methadone."
Tu and Weiss believe the solution is simple: The province should pay pharmacists only one dispensing fee per prescription, not every time they dispense a single pill.
"If people weren't making money out of these daily dispense meds, there wouldn't be the need to be behaving this way," Weiss said. "If there was only a weekly dispensing fee at max, this wouldn't happen."