Canadian health care facilities report hundreds of ‘unexplained’ fentanyl disappearances

Deadly fentanyl disappeared from Canadian hospitals, health centres and veterinary clinics more than 500 times between 2018 and this March, according to data obtained by the Star.

Health Canada records list 483 reported fentanyl disappearances as unexplained," another 50 as pilferage," two as theft and one as a break and entry.

In the data, pilferage is defined as theft from a site by authorized personnel."

In total, there were 540 fentanyl disappearances reported to Health Canada from Jan. 1, 2018, to March 10, 2023, according to the data.

My initial reaction is shock and frustration," said Michelle Arnot, professor, of Pharmacology & Toxicology in the Temerty Faculty of Medicine at the University of Toronto.

My second reaction is that although there have been changes in tracking prescription of fentanyl and opioids., there clearly needs to be better and more rigorous guidelines for tracking and follow up at the institutional' and organizational' level," said Arnot, whose expertise is substance-use disorders and harm reduction.

A former organized criminal who sold and used fentanyl before working with authorities said that there's a strong demand for medical fentanyl on the streets.

The former criminal was a senior member of the United Nations gang before becoming a co-operating witness with authorities.

People want the stuff from hospitals because you know it's the good s---," he said.

When criminals try to make fentanyl themselves, it's all just buffed and cut and mixed," the former drug dealer said - basically garbage dope for high-end prices,"

So when you can get it from the hospital, you know it's pure," he said.

Steps are being taken to cut the diversion of drugs, Dr. Sean P. Spina, president of the Canadian Society of Hospital Pharmacists, said in an interview.

Those include requiring double signatures from nursing staff and pharmacies, installing closed-circuit cameras in storage areas, and eliminating the amount of wastage of opioids.

We do need to build better systems," Spina said.

Medical diversion of drugs is a shared responsibility across the health care system, said Spina, whose organization represents almost 3,800 hospital pharmacists and technicians across Canada.

The purpose of hospital pharmacy is to make sure patients receive the medications they need at the right time and in the right combination," Spina said. Changing processes and systems to reduce drug diversion is a necessary part of this equation for best possible patient outcomes."

Drug theft from medical facilities is common, yet often preventable," according to a 2019 report by the Canadian Society of Hospital Pharmacists.

Most health professionals who steal drugs from their workplaces do so for personal use and not to sell the drugs on the street, the report continues.

Such diversion puts patient safety, staff safety, and public health at risk."

The report acknowledges the point made by the former drug dealer: some of the stolen drugs find their way onto the street because increased contamination of street drugs has increased the demand for safer' pharmaceutical-grade opioids diverted from the health system."

That said, the report stresses that in most cases, the health worker who diverts the drug is suffering from substance-use disorder."

The Star search of government records covers loss and theft reports submitted to Health Canada involving fentanyl in the form of vials and patches.

Ontario had the overwhelming majority of fentanyl disappearances, with 374 of the 540 Canadian cases.

The Health Canada data states 198 of the disappearances were from hospitals and 310 from long-term care facilities, with the rest from veterinary hospitals.

In hospitals, there are already rules that controlled substances such as fentanyl must be secured and locked, access must be restricted to designated staff, and random audits must be conducted by the hospital to prevent loss, theft or diversion, according to a statement from the Ontario College of Pharmacists.

These processes are discussed during routine hospital pharmacy assessments conducted by the College's operations advisers, the statement continued.

Fentanyl - a particularly fast-acting, highly potent and addictive opioid - is one of the key drugs fuelling North America's ongoing opioid crisis.

Fentanyl is estimated to be 80 times as potent as morphine and hundreds of times more potent than heroin," a Centers for Disease Control and Prevention website says.

Peter Edwards is a Toronto-based reporter primarily covering crime for the Star. Reach him via email: pedwards@thestar.ca