METHADONE USERS 'GET PHARMACY KICKBACKS'

Downtown Eastside Health Workers Take Issue To The Media

Health workers on Vancouver's Downtown Eastside say they've
complained for years about methadone users being offered kickbacks
from pharmacists to fill their prescriptions.

Despite their complaints, nothing was done until they approached the
media, said Doreen Littlejohn, a nurse who works at the Vancouver
Native Health Society.

"We all know about it. The clients know about it, we know about it,
but it's like it's falling on deaf ears," Littlejohn said. "We're
trying so hard to treat these people and we're being undermined by
poor pharmacy practices. I really think the province has to look at this issue.

"It's all about money and it's not about health. I find it morally repugnant."

B.C. authorities said they're investigating the allegations. Health
Minister George Abbott said Monday his ministry got a letter from a
doctor in January and officials have been investigating ever since.
He would not say if the probe involved more than one pharmacy or what
agencies were involved.

"I don't want to disclose at this point how broad it is in terms of
agencies engaged," Abbott said, adding it could jeopardize the case.
"I can just say it's extensive."

He did say, however, he takes the concerns "very seriously."

"We've been trying to get to the bottom of it to try and ascertain
all the facts and evidence."

Abbott said the allegation in the case is that methadone users are
given a small amount of cash so they will use a given pharmacy.

The deal benefits patients, who get an instant payout, and pharmacies
that get a sustained flow of daily business. The deal is also
strictly prohibited, Abbott said, under the agreement in place
between B.C. and its pharmacies.

Littlejohn said the problem has worsened in the past six to nine
months. Pharmacists are now openly soliciting patients to change
their prescriptions in exchange for cash incentives that range from $10 to $40.

This puts pressure on the clients to get the prescriptions, she said.
Some take other drugs to make it look like they need methadone when they don't.

"They want to be on it to gather the kickback and take the methadone
and sell it," Littlejohn said.

The dispensing of methadone for Pharmacare patients is a big business in B.C.

Pharmacies are given an $8.60 fee to dispense a daily dose of
methadone, and an extra $7.70 to supervise the patient while he or
she takes the dose.

In the last fiscal year, pharmacies across B.C. made $27 million in
methadone-related fees through Pharmacare.

New Democratic Party health critic Adrian Dix called the situation
"completely outrageous and unacceptable," and questioned why it has
taken so long for the government and other authorities to respond.

"How many fees have been paid out since they were first informed of
these problems, and what has the government actually done?" he said.

The College of Pharmacists of B.C., which also received the
complaints, has been conducting a "collaborative and complex
investigation," registrar Marshall Moleschi said.

He declined to give further details of the complaints, including what
pharmacies are implicated or their locations.

The College of Pharmacists has the power to issue fines, suspend
licences or order a pharmacy to be shut down.

The College of Physicians and Surgeons of B.C., which also received
the complaints, is not involved in the investigations.

Alexander Tam, a pharmacist at Eastside Pharmacy, which dispenses
everything from antiretroviral drugs for HIV to methadone, said the
incentives have put a "black mark on our profession."

"I have patients coming in here and say: 'I have this methadone
script, how much do you pay?' I say, 'Sorry man, I don't pay.' That's
not the way to do business," he said.

Littlejohn worries that pharmacies offering cash incentives are not
properly monitoring their patients' prescriptions or discussing side
effects. One young woman was given a double dose of methadone, Littlejohn said.

She's also concerned that HIV patients may use the money to buy drugs
and forget to take their antiretroviral medication, which would lower
their resistance.

Littlejohn argues the problem could be resolved by allowing
pharmacists only one dispensing fee per prescription.

A pharmacist at the AYC Pharmacy on East Hastings refused to speak to
The Vancouver Sun.

But one of her patients, methadone user Francine Nantel, said she has
never been offered any incentives.

"She gives us cookies and hot chocolate, we've never been offered
money," Nantel said. "You're causing us this kind of problem, we're
not going to have a pharmacy anymore."