Nova Scotia drug monitoring program 'not working the way it was intended'

A licensed pharmacist who helped design Nova Scotia's prescription monitoring program about 20 years ago says the program has strayed from its original mandate by failing to blow the whistle about an alleged case of "completely off-the-scale" over-prescribing.

Police accuse Sarah Jones, a 35-year-old doctor in Tantallon, N.S., of writing prescriptions to a single patient, Merel Chase, for 50,000 oxycodone and oxyneo pills between January 2014 and August 2015.

Police allege Jones then picked the pills up herself to traffick them. She's due in court in May.

"Absolutely it should have been caught sooner. I don't know how that could have happened," said Nadine Wentzell, who now works with employers implementing workplace drug abuse programs.

It was a pharmacist who reported the suspicious activity to the College of Physicians and Surgeons, the profession's governing body, which in turn called police last August.

10 times the typical dosage

The prescription monitoring program will not discuss any details of this case. But Wentzell says the drug monitoring program failed to nip this case in the bud.

"I don't think you can provide enough vigilance or oversight or investigation when it comes to prescription drug abuse," she said.  

Wentzell says the prescription monitoring program was designed to red flag each prescription that exceeds the medications recommended dosage.

In the case of oxycodone, a highly addictive and potentially lethal opioid painkiller, a typical dosage is eight pills a day, or 240 pills a month.

It's alleged Jones was prescribing 10 times that amount, and that it continued for 20 months.

Spotting a pattern

Wentzell says the flagged prescription would then be sent to the program's review committee, which is made up of pharmacists and physicians, and would meet monthly to investigate cases. She says it has the power to take action quickly.

"Ideally within the first two to three months, and realistically two. From my experience you begin to see a pattern over that period of time and you have enough information, factual information from which to investigate further and take it to the regulatory bodies and the police," she said. 

The College of Physicians and Surgeons has the authority to probe a doctor's prescribing practice, and impose conditions on their ability to work, while police investigate whether drug diversion for criminal purposes is happening.

"There's nothing to say they can't run parallel," said Wentzell, who also has 10 years under her belt as a former narcotics inspector with Health Canada.

'I don't think it's effective'

The prescription monitoring program has not referred a case to police since 2014.

According to its annual report, in 2011-2012 police were called four times. The following year, it was down to two cases, while in 2013-2014, three cases were sent to police.

The Nova Scotia government hired Medavie Blue Cross to run the program in 2005, and the contract is up for renewal in 2017. The company was paid $923,000 to run the program in 2014-2015.

A spokesperson for Medavie Blue Cross says the company will not discuss its prescribing thresholds used to report fishy cases "so as to not compromise the effectiveness of the program."

Wentzell says the program has evolved and changed, but in this case of alleged massive over-prescribing, "I don't think it's effective and it's certainly not working the way it was intended."

Changes coming

The province is planning to augment the prescription monitoring program with the Drug Information System.

A Department of Health spokesperson says it will be rolling out by the end of June and will provide more information to the monitoring program.

"Hopefully that system will identify and address the inadequacies of what's obviously failed," said Wentzell.