Saskatchewan·In Depth

Hydromorphone disappearing from Sask. pharmacies at a high rate

A CBC News investigation examined what drugs are going missing from pharmacies and hospitals in Canada. It discovered that in Saskatchewan, the potent opioid hydromorphone is the most common medication to be reported lost.

CBC investigation finds hydromorphone most common to be reported lost

Hydromorphone is the drug that goes missing most often from Saskatchewan pharmacies. (Elizabeth Chiu/CBC)

Christopher Kurek says he got his hands on hydromorphone less than an hour after entering a detox centre in Prince Albert.

"It was easy there actually 'cause the detox centre was situated right beside some dealers' houses," he said.

"As soon as I went there, like not even 20 minutes later, I'm not exaggerating, I had some pills and everything right there."

Now Kurek's only opioid use is a daily dose of methadone, which he hopes to be off by the end of the year.

Kurek said morphine and fentanyl patches used to be his go-tos. Hydromorphone or its generic equivalent Dilaudid, known as "dilly" by users, was also popular.

"I knew lots of people that did those."

Hydromorphone is a potent opioid with a high street value. In Saskatchewan it's the drug that most commonly goes missing from pharmacies, according to a CBC News investigation.

Christopher Kurek is a former opioid user who is now on a methadone program. He says it's easy to find drugs like hydromorphone on the street. (Craig Edwards/CBC)

Millions of drugs lost across Canada

When a drug is lost or stolen, a pharmacy, transport company or hospital must report details of the loss to Health Canada within 10 days.

CBC News obtained all loss reports across Canada between Jan. 1, 2012 and Sept. 30, 2017 through an access-to-information request. Over that time period, 142,420 individual loss reports were filed.

The reports showed a jump in how many drugs are being lost. In Saskatchewan, drug losses increased to more than 70,000 units — which could be pills, capsules or other individual doses of medication — last year compared to around 56,000 in 2012.

Over the past five years, more than 350,000 units of drugs were reported lost in Saskatchewan, mostly from pharmacies.

Health Canada did not grant CBC an interview, but ties the increase in reported loss to the agency's launch of a community pharmacy inspection program back in 2015.

According to the agency's website, there were 359 pharmacies in Saskatchewan that year and as of 2016-17, 11 pharmacies had undergone an inspection.

Hearing that hydromorphone is the drug that goes missing the most from Saskatchewan pharmacies isn't a surprise to police, addictions workers and even pharmacists themselves.

"Hydromorphone for sure is our number one prescribed and dispensed opioid here in Saskatchewan," explained Julia Bareham, who oversees the prescription review program for the Saskatchewan College of Physicians and Surgeons.

At least 150,000 hydromorphone prescriptions last year

Saskatchewan's Ministry of Health says in 2017, it covered more than 150,000 prescriptions of hydromorphone under the province's drug plan — up significantly from 2010 when it accepted 84,238 prescriptions.

To compare, the province covered 33, 873 prescriptions of morphine last year. 

Bareham said that compared to other oral opioids, hydromorphone is the most powerful.

Dr. Peter Butt teaches medicine at the University of Saskatchewan. He says hydromorphone is five times more potent than morphine. (CBC)

Dr. Peter Butt, who teaches medicine at the University of Saskatchewan and is on the province's task force to address opioid deaths, said hydromorphone is five times more potent than morphine.

He said it's more readily available in the province because it is highly prescribed.

"If you think about this from a supply and demand point of view, if in the drug economy the demand is greater for hydromorphone, then supply chains are going to respond."

Julia Bareham with the Saskatchewan College of Physicians and Surgeons says hydromorphone is the opioid that gets prescribed and dispensed the most in the province. (CBC)

Powerful, potent opioid 

Bareham agrees there is a connection between prescribing patterns and what drugs people end up addicted to.

"It's certainly more potent than all the other oral opioids available so if someone is drug seeking that would definitely be something they may be drawn to a result," she explained.

"If you're looking to really get the best bang for your buck, if you will, in terms of a high, it's probably the go-to in terms of oral drugs that are out there."

She said prescriptions of fentanyl are typically ten patches for thirty days, but with hydromorphone people could be getting more than a hundred pills for the same time period.

Bareham explained short acting hydromorphone or dilaudid goes by the street name 'dilly' while hydromorph-contin, used for sustained relief, is a capsule that contains tiny balls and is referred to as 'beads.'

"Everyone's always looking for the dilly."

Costs up to $150 on the street

According to Saskatoon police, the street price for a six milligram hydromorphone pill is about $20, but a 100 milligram pill can range in price from $100 to $150.  

Marv Zehner, director of the Parliament Methadone Program says hydromorphone is very popular.

Marv Zehner is the director of the Parliament Methadone Program in Regina.

Zehner said hydromorphone is popular among his clients and has been for the past decade or so.

"The old school people, you always used morphine. So now you take a one-hundred milligram morphine pill and you take a 30 milligram hydromorphone and it's going to be 100, 150 times stronger than that morphine, so I mean it makes sense to spend your money on something you're going to get more out of than not, right."

"It's available on the streets all over the place."

Second deadliest opioid 

Hydromorphone is also the second deadliest opioid in Saskatchewan according to yearly drug statistics provided by the Office of the Chief Coroner.

From 2010 to 2017, 707 people died after taking opioids in Saskatchewan, with around 182 of those deaths attributed to hydromorphone. Methadone claimed the most lives.

Half a million drugs lost to theft

Each year about half a million drugs are reported lost to Health Canada due to thefts across the country. Experts say stolen pills can end up in the hands of addicts and users at the street level.

In Saskatchewan, an increasing number of drugs are being taken in armed robberies, reports show. In 2017, more than 17,000 drug units went missing due to armed robberies, compared to only 960 reported in 2012.

Meanwhile, the number lost from break and enters is decreasing.  Last year, 21,296 unit of drugs were reported stolen in break and enters compared to 48,233 in 2012.

'I don't want to experience that again'

Pharmacy manager Matt Manz has had drug stock stolen three times, twice through break and enters and the third time last December when someone entered his pharmacy on Dewdney Avenue in Regina with a knife.

"[They] point blank said, 'Give me morphine, give me the fentanyl, give me your benzodiazepines,' and had a knife in their hand right to my face.

"I don't ever want to experience that again."

Saskatoon police responding to an overdose call in the 3000 block of Arlington Street back in March. (Dan Zakreski/CBC )

Kim Cook operates a pharmacy in Melville and was also robbed last year.

Cook said a masked suspect came into the pharmacy through her back door and made it seem like he was carrying a gun in his pocket.

"He asked specifically for hydromorphone and then later changed his request to any narcotics that we had, any and all."

RCMP in Saskatchewan say in 2017, there were nine reported break and enters, with hydromorphone being mentioned in seven of the incidents.

So far this year, RCMP report two break and enters where fentanyl, oxycontin, and hydromorphone were mentioned.

Spokesperson Cpl. Rob King says police believe the same suspect is responsible for all three robberies.

RCMP Cpl. Robb Karaim is a supervisor with federal, serious and organized crime in Regina. He said drug abusers prefer to get pills on the street, by purchase or even theft.

He said in crimes like a break and enter, the suspect is often a drug user who would keep some pills and sell some. Karaim said in his experience such thieves are not connected to organized crime.

"The robberies would be someone who's desperate to get their hands on it. It's high risk 'cause you got a very high risk of getting apprehended for it," he said.

9,000 units of hydromorphone lost with no explanation 

The fastest-rising category for losses is "unexplained."

Biggest loss turns out to be reporting error 

During its investigation, CBC News found 27 loss reports all dated July 29, 2017 from pharmacies. They detailed the loss of nearly 400,000 units of mainly hydromorphone under the category of "other." 

After contacting Saskatchewan's College of Pharmacy Professionals, it turned out these reports were filed in error by one pharmacy. It was then excluded from analysis. 

In a recent email to CBC News, registar Jeana Wendel said an inspector from the college audited the pharmacy and discovered there was no loss and concluded it was clerical error. Wendel said it was a result of a change in management as the pharmacy. 

Wendel said the college's records shows that pharmacy was also audited by Health Canada and no issues were reported. 

She said the pharmacy has been directed to fix its error with the agency. 

Of the nine million doses of drugs reported missing over the past five years, Health Canada has no explanation for around three million. 

In Saskatchewan, the two biggest losses were reported in June 2016, when more than 9,000 doses of hydromorphone were reported gone with no explanation. 

Bareham said after working in a community pharmacy for more than a decade, she can see how human error happens overtime, like a pill bounces away and you cannot find it. However, she said this increase raises concerns about possible staff diversion and whether pharmacists are properly processing prescriptions. 

"Certainly concerning, especially when we know that medication like hydromorphone definitely has high street value."

Butt said expressed similar questions and said it is up to Health Canada to answer. 

Every year, hundreds of thousands of controlled drugs (mostly opioids) that were supposed to end up on pharmacy shelves are reported missing to Health Canada — and that number is on the rise. Vik Adhopia explains what might be going on. 1:48

"Clearly if we're not able to account for the drugs that are somehow disappearing and we have a significant problem in this province with deaths related to prescribed opioids then we need to get on top of this information.  We need to find out."

The Saskatchewan College of Pharmacy Professionals did not grant an interview for this story. 

Matt Manz says his pharmacy has been broken into twice and was held up by knife point last year.

Supply and demand 

If we're going to just acutely sort of rip those drugs away from them and put them into withdrawal I'm not surprised that this is what is happening,- Julia Bareham, pharmacist manager, Saskatchewan College of Physicians and Surgeons

Manz said there is an escalation in both the severity and frequency of thefts taking place against pharmacies and sees two possible explanations.

For one, Manz said, the uptick in armed robberies and decrease in break and enters could be tied to pharmacists increasing the security around their dispensaries, making it harder for a suspect to steal drugs when no one is around.

Second, he thinks the increase in robberies is in response to national efforts to tighten up the prescribing of addictive opioids.

In the past opioids like hydromorphone were prescribed to treat chronic pain, but there's been a recent shift to treat chronic pain using non-pharmacological options or Tylenol, Manz explained.

Opioids are now used mostly for cancer, palliative care or post-operation care.

"I think maybe it's because it's harder to get a lot of so now, with the guidelines changing, access has been decreased. There's probably going to be less on the street so now we have to figure out what to do with that," said Manz.

'It is certainly concerning'

He added there are opioid replacements available like methadone and suboxone, but if people do not want to take those they may turn to armed robberies and theft to access the drugs they crave.

"I feel like now that's what it's come to."

Bareham also framed the issue as one of supply and demand.

"It's certainly concerning," she said, adding it speaks to what type of resources exist in the community to help people struggling with drug addiction.

"If we're going to just acutely sort of rip those drugs away from them and put them into withdrawl I'm not surprised that this is what is happening."

About the Author

Stephanie Taylor

Reporter, CBC Saskatchewan

Stephanie Taylor is a reporter based in Saskatchewan. Before joining CBC News in Regina, she covered municipal politics in her hometown of Winnipeg and in Halifax. Reach her at stephanie.taylor@cbc.ca