METHADONE KICKBACKS INVESTIGATED

At Least One Pharmacy Allegedly Gave Cash to Addicts for Prescriptions

A pharmacy in Vancouver's Downtown Eastside is being investigated for
offering heroin addicts cash in exchange for filling their methadone
prescriptions.

The methadone maintenance program can be lucrative for pharmacies,
representing as much as $54 million a year in provincially paid
dispensing fees.

"We have received at least one complaint; there may be more," said
Health Minister George Abbott. "We received one letter from a
Vancouver physician in January" about the practice at the pharmacy.

He said the ministry, the College of Pharmacists of B.C. and the
College of Physicians and Surgeons, which administers the program,
are investigating the pharmacy, which he wouldn't name.

"There is an investigation and all of us are concerned of any
potential violation," said Abbott. He said he didn't know how many
pharmacists are being investigated.

Spokeswoman Lori DeCou of the College of Pharmacists confirmed there
was an investigation but wouldn't disclose any other details.

The physicians' college spokeswoman, Susan Prins, didn't respond to a
request for comment.

Untreated heroin addicts who opt for methadone to reduce cravings
require daily doses. Because of the fear they will resell the drug on
the streets, most are required to visit a pharmacy daily and ingest
it under a pharmacist's observation.

The pharmacist receives the regular dispensing fee of $8.60 for
filling the prescription and an additional $7.70 fee for witnessing
the ingestion -- or up to $6,000 per user a year. The province also
reimburses the pharmacy for the cost of the methadone, at around $1.40 a visit.

That amounts to a possible $54 million in dispensing fees for the
estimated 8,400 methadone users in B.C.

In the 2007-2008 fiscal year, PharmaCare reimbursed pharmacists $27
million through the methadone maintenance program, according to B.C.
Health spokeswoman Michelle Stewart.

Under the province's PharmaCare regulations, pharmacists are not
allowed to offer cash or other incentives, including air miles,
loyalty points or bus passes, to methadone users or to advertise drugs.

Some pharmacies in Vancouver's Downtown Eastside post signs in the
windows advertising methadone and openly hand out cookies and coffee
to those filling methadone prescriptions.

Addicts report getting cash, too.

Kickbacks to addicts are a problem in Surrey.

Mayor Diane Watts said there are pharmacies in the downtown area in
the Whalley district that dispense only methadone.

"The issue is when some of the dispensaries pay for some of the
clients' prescriptions," she said.

Pharmacists who follow the rules have complained to the Downtown
Surrey Business Improvement Association that methadone clients expect
payment for filling their prescriptions at their pharmacies.

"They tell them they've been offered money to take their
prescriptions elsewhere," said executive-director Leslie Tannen.

She said heroin addicts are typically also addicted to crack, cocaine
or prescription drugs and dealers set up next to the methadone
dispensaries and openly traffick to them as they leave the pharmacies
with cash in hand.

Watts said council intends to pass a bylaw that would allow only
full-service pharmacies. Surrey is also expected this fall to pass a
new bylaw to restrict new pharmacies from setting up within 400
metres of existing drug stores.

And about five years ago, council hiked the yearly business licence
fees for pharmacies to $10,000 from $195, a fee that was later
reduced to the $3,000 yearly maximum.

"Let's just say nothing's changed," said Tannen.

She said the college of pharmacists needs to do more to control its
members, and she doesn't buy the excuse the payments are hard to prove.

She said she supports harm-reduction for addicts but asked, "Why is
the taxpayer paying the bill for the vast majority of people on
methadone who are getting cash inducements to buy more drugs?

"Taxpayers need some comfort that the program is administered in a
medically appropriate and fiscally prudent way.

"Perhaps the whole program has to be examined," Tannen said.