While this represents just 1.5 per cent of the more than 16,000 pharmacists in the province, the investigation found this even small number of health-care professionals can cause a disproportionate amount of harm to patients and to the public purse.
“Most pharmacists are tremendous people. They’re knowledgeable, they’re extremely helpful and they are an important part of the health-care team. The very small number of pharmacists, or doctors for that matter, who engage in this sort of behaviour, cause a lot of harm,” said Dr. David Juurlink, professor of pharmacology at the University of Toronto.
During those five years, the college sanctioned 15 pharmacists for illegally dealing prescription medication, nine of whom dealt opioids. Health Canada data suggests the actual number could be far greater because there are more drugs missing from pharmacies than prosecutions and disciplinary cases can account for.
Nearly 3.5 million doses of prescription drugs disappeared from Ontario pharmacies from 2013 to 2017, the data shows. And the growth is startling: from about 2,200 reports of drug losses in 2013 to more than 30,000 last year. The vast majority of those losses were dangerous opioids.
For example, annual reported losses of hydromorphone — a opioid five times more potent than morphine — rose from about 21,000 to 63,000 tablets in the five years, totalling more than 200,000 tablets missing from pharmacy shelves.
Three-quarters of reports listed the reason for the drug losses as “unexplained.”
Health Minister Christine Elliott declined an interview request for this story but spokesperson Haley Chazan sent a statement:
“Our government takes patient safety very seriously. The inappropriate use, abuse and diversion of prescription narcotics and controlled substances are very serious public health concerns,” the statement read. “Minister Elliott will continue to work with partners to discuss harm reduction strategies and ensure those struggling with addiction get the help they need.”
While sources of street opioids vary, and most are illegally imported, the morphine, hydromorphone, oxycodone and fentanyl that originates in the health care system is an alarming trend.
Opioid-related deaths in Ontario have almost doubled in the last five years, rising from 639 in 2013 to 1,265 in 2017, according to Public Health Ontario. More than 70 per cent of opioid deaths involve fentanyl, according to federal data.
“It’s quite often the case that people who end up with opioid addiction, who are at a very high risk of death, began with experimentation on a pill that was prescribed to someone else,” Juurlink said. “Aside from being criminal and deeply unethical, a pharmacist who introduces large amounts of opioids into society — or any other drug prone to abuse — is perpetuating harm in a very real way.”
The police investigation into Shaheen found that he trafficked more than 5,000 fentanyl patches with a street value of over $1 million.
Each patch is typically cut into four before being sold to an addict who eats, smokes or injects the contents. And because of its potency, each quarter patch could kill anyone who doesn’t have a high tolerance for opioids.
After discovering that an assistant in his pharmacy had reported the large orders of patches in his store to the college of pharmacists, Shaheen scrambled to cover his tracks.
“The robbery accomplished exactly what Mr. Shaheen had sought. It allowed him to falsely claim that a large amount of fentanyl had been stolen, an amount that he knew had not been taken,” Judge Robert Wadden said at Shaheen’s sentencing.
“As a trained professional, he would have been aware of the debilitating and deadly effects of this drug in the hands of addicts. Yet he conducted a drug trafficking scheme worth over a million dollars, profiting off the misery of others.”
Two days before the robbery, Shaheen met the man to whom he had been selling the patches in a McDonald’s.
“I need your help,” Shaheen told Mehdi Rostaee.
“Can you send somebody to the pharmacy … when I am there?” Shaheen asked. “I will give him whatever I have in the safe,”
“OK,” said Rostaee, whose surreptitious recording of the conversation was entered into evidence during Shaheen’s trial last October. “When do you want to do it?”
“Sunday,” Shaheen responded.
“You’re alone?” asked Rostaee.
“Yeah … We have to be smart and natural about it.”
Ottawa police who arrived the afternoon of the faked robbery in October 2014 described Shaheen as “scared” and “very stressed.”
“He was very nervous, in fear still when I met him,” Det. Guy Seguin said in a recent interview, “to the point where I reached out to our victim crisis unit to call him for a followup, which I never did before in any other pharmacy robbery.”
Seguin was told by Shaheen’s assistants about the large fentanyl shipments, and forged prescriptions for 99 patches per month that Shaheen had filled for Rostaee.
When confronted by police, Rostaee provided a cellphone recording of the McDonald’s meeting. (Contacted by the Star and Global, Rostaee denied carrying out the robbery.)
“Mr. Rostaee’s testimony and co-operation … was a key part of that investigation,” Seguin said after Shaheen was sentenced March this year. “It’s possible that Mr. Shaheen could have gotten away.”
Shaheen is appealing and his pharmacist’s licence has been suspended indefinitely. Rostaee pleaded guilty to forging the fentanyl prescriptions and was given a conditional sentence.
Shaheen declined interview requests, but in an email, his lawyer said he “continues to assert his innocence and is hopeful that his appeal will be successful.”
He isn’t the only Ontario pharmacist who faked a robbery to cover up opioid dealing.
Michael Yamasaki, pleaded guilty this summer to 11 charges related to orchestrating a robbery at his pharmacy in Georgina last year. More than $110,000 of prescription opioids disappeared, for which Yamasaki was supposed to be paid $10,000.
Yamasaki, who did not respond to an interview request, has not been sentenced.
He was caught by old-fashioned police work, which led investigators to the storage space where the stolen drugs had been stashed.
The nine pharmacists caught dealing opioids in the last five years are alone responsible for putting more than 8,000 fentanyl patches — 32,000 potentially lethal doses — onto the street, the investigation found.
Yet drug-dealing pharmacists remain off the province’s agenda, says Allan Malek, vice-president of the Ontario Pharmacists Association, who meets regularly with Ministry of Health officials to discuss the opioid crisis.
“I actually sit on the ministry’s opioid emergency task force,” he said. “There’s been no concern raised at the opioid emergency task force of pharmacists being that conduit … Pharmacy has not hit the radar screen.”
Currently, drug wholesalers are not required to report suspiciously large orders of opioids by pharmacies. While the province has the tools to track every dose of narcotics in the province, it hasn’t caught a single drug-dealing pharmacist.
Since 2012, all narcotics dispensed in Ontario are tracked by the Narcotics Monitoring System (NMS), which was introduced to “identify and reduce the abuse, misuse and diversion of monitored drugs.”
Juurlink says the system is poorly designed and doesn’t update in real time, limiting its usefulness.
“It’s kind of crazy in 2018 that a child can go online and play a video game in real time with somebody thousands of miles away, but a pharmacist in downtown Toronto doesn’t have real-time access to all of the prescription information for the patient in front of him or her from the pharmacy across the street,” he said.
The system will flag when a pharmacist is asked to fill a prescription that has been filled elsewhere. But, “the set of things that has to happen to trigger a flag is a little bit of too high a bar in my view,” Juurlink said.
Chazan, the Health Ministry spokesperson, said the “Narcotics Monitoring System does not monitor pharmacy inventory, and was not established to proactively detect diversion or criminal activity.”
However, the Narcotics Monitoring system handbook states that “the collected data will be reviewed and analyzed by the Ministry of Health and Long-Term Care for a variety of purposes including, … reporting possible criminal conduct to law enforcement agencies.”
While the Narcotics Safety and Awareness Act specifies $50,000 fines to pharmacists and $200,000 fines to pharmacies that input “false or misleading information,” not a single charge has ever been laid, according to a Health Ministry spokesperson.
In the United States, lawsuits have been launched against several drug distributors, including McKesson — which is one of the biggest and also operates in Canada. It agreed to pay $150 million for failing to report suspicious pharmacy orders for opioids.
When Keswick pharmacist Shamik Patel was arrested for dealing drugs in 2014, it was thanks to a police informant.
Yogesh Patel (no relation to Shamik Patel) was particularly creative in his drug dealing methods.
The Woodstock pharmacist, who pleaded guilty last year to stealing 3,000 fentanyl patches and 1,500 hydromorphone tablets, covered his tracks by forging prescriptions for dead people.
He was only caught when he unwittingly walked into a police surveillance operation with a bag full of drugs. Patel had no idea the man he was meeting in a parking lot was being tracked by police.
“They observed Mr. Patel leaving the pharmacy with a bag in which they suspected he was carrying fentanyl from the pharmacy,” said Jim Dean, a London, Ont., lawyer who represented Patel. Until then “he was not on the radar at all,” Dean said.
In fact, the College of Pharmacists assessed Patel’s pharmacy less than a week before he was arrested and gave it a “pass.”
“Those who engage in unlawful conduct often take great effort to conceal their behaviour,” said Todd Leach, a spokesperson for the college, when asked about the successful assessment.
Leach said that the college assessments aren’t designed to find missing drugs but that more detailed assessments will start in 2019.
After witnessing that drug hand-off, police audited Patel’s pharmacy records and found large amounts of fentanyl had been disappearing.
Patel forged prescriptions with names he found in obituaries or just made them up. He also filled out paperwork to show he had transferred large amounts of fentanyl to other pharmacies that never received the shipments.
The college revoked Patel’s licence in July 2017. That September, he was sentenced to 11 years in prison. In his decision, Judge Edward Graham didn’t mince his words.
“Mr. Patel had the highest duty to protect the public. Instead he placed members of the public at great risk of harm … His moral blameworthiness is exceptionally high,” Graham said.
With files from Sarah Bhola, Centennial College, Ryan Moore, Ryerson School of Journalism and Leslie Whyte, Global News.
Robert Cribb is a Toronto-based investigative reporter. Follow him on Twitter: @thecribby
Marco Chown Oved is a Toronto-based investigative reporter. Follow him on Twitter: @marcooved