‘Hillbilly heroin’ dispensed on defaced, altered handwritten scripts

A pharmacist has had his bid to reinstate his registration knocked back in a Tribunal hearing which noted that his former store now belonged to his son

In June 2018, the NSW Civil and Administrative Tribunal had ordered that the pharmacist’s registration be cancelled, and that he was not entitled to apply for a review of that order for 24 months.

Now, the pharmacist requested that his registration be reinstated, and said that he would comply with any conditions the Tribunal considered appropriate.

The Health Care Complaints Commission opposed this request, contending that the pharmacist had not demonstrated that he had been rehabilitated.

The Tribunal heard that in September 2013, while reviewing records relating to the sale of OxyContin in NSW, the Pharmaceutical Services Unit took note of the purchasing record of the pharmacist’s store.

It observed that the pharmacy he owned and operated had purchased an “unusually high” quantity of OxyContin 80mg tablets.

“Sometimes referred to as ‘hillbilly heroin’, OxyContin is a high-strength opioid analgesic,” the Tribunal observed. “While recognised as having a proper therapeutic purpose, it is also recognised that OxyContin is subject to abuse and trafficking.”

A PSU investigator identified a “series of irregularities” in the pharmacy’s records, including the S8 register; and in March 2014, the investigator served an order on the pharmacist.

This prevented him from obtaining, possessing or supplying S8s, except methadone and buprenorphine for the purposes of treating patients on an Opioid Treatment Program. The next month, the Pharmacy Council of NSW imposed conditions on the pharmacist’s registration, reflecting the PSU’s order.

The HCCC then referred a complaint to the NSW Civil and Administrative Tribunal, comprising seven complaints about the pharmacist’s conduct in dispensing various drugs – primarily OxyContin – and one which contended that these complaints amounted to professional misconduct.

Each complaint was proven, as was unsatisfactory professional conduct; one complaint (Complaint 3) had constituted professional misconduct.

At the time, the Tribunal summarised the conduct, saying that the pharmacist “dispensed huge quantities of high strength OxyContin over a 14 month period without exercising the appropriate professional judgement to ensure that it was being taken by actual patients in clinically indicated and supervised circumstances”.

“The possibility of misuse of this kind of drug is very significant, and the likelihood of misuse of the drugs that [the pharmacist] was dispensing increased exponentially over time: in particular when he dispensed increasing quantities of high strength OxyContin into the hands of a single individual on the basis of handwritten private scripts, many of which were defaced or altered, issued in the name of a single Doctor.

“There were also numerous other proved instances of inappropriate dispensing of Sch 8 medications, principally OxyContin, on incomplete, altered or suspicious scripts during the same time period.”

Throughout, the pharmacist did not report suspicious scripts or doctors to the relevant authorities, the Tribunal had noted.

Complaint 3, about behaviour which was found to have constituted professional misconduct, involved the dispensing of large quantities of OxyContin between early December 2012 and early March 2014, “purportedly to 46 patients in circumstances where each prescription was issued by the same prescribing practitioner, Dr BW”.

The medicines were not dispensed with directions for use, and were all collected by the same person – identified as Patient D – who did not provide any form of patient authority to collect the scripts, and who paid for the medicines in cash.

The pharmacist said he did not know Patient D’s surname or occupation, nor did he sight or ask Patient D to provide any form of identification.

“Between 2010 and 2014, the Pharmacy dispensed 143,884 OxyContin tablets for prescriptions issued by Dr BW: 14,000 in 2010, 31,000 in 2011, 31,000 in 2012, 52,000 in 2013 and 13,400 to 20 March 2014,” the Tribunal noted.

“Most of the subject prescriptions were for high-strength OxyContin (generally 112 tablets of 80mg) and were presented at ‘short intervals’ over prolonged periods,” the Tribunal noted.

“This had the potential for the dosage to exceed ‘recognised therapeutic standards’ ie a maximum of one tablet twice a day.”

The scripts were all private prescriptions, and as observed by the Tribunal, “many of the subject prescriptions had been altered, with large parts blacked out, and were missing key details required to be included by law, such as the prescription pad ID number”.

The pharmacist should have held serious doubt or concern about these scripts and/or the prescribing practices of Dr BW, and failed to notify authorities.

He had also dispensed large quantities of the medicines to Patient D without obtaining consent from the patient for whom the script was written.

Dr BW denied issuing any of the scripts, saying he rarely prescribed OxyContin.

He also said he did not know patient D and had not been contacted by the pharmacist or asked to examine the scripts, though at the time the Tribunal rejected this claim and found the pharmacist’s alleged failure to confirm the authenticity of the scripts to be not proven.

The pharmacist had tendered CCTV footage from 2012 which showed Patient D and Dr BW meeting him at the pharmacy.

The Tribunal came to the “inescapable conclusion” that the pharmacist “had a consciousness of wrongdoing, and specifically that Dr BW’s scripts or prescribing practices were not legitimate”.

Despite his knowledge of this wrongdoing, the pharmacist continued to dispense very large quantities of high strength OxyContin for the next 17 months – until he was prevented by the PSU.

The original Tribunal found the pharmacist was prepared to “tailor and falsify his evidence under oath” and said his explanation of his understanding of his responsibilities around S8s to be “implausible and unconvincing”.

He had said he was unaware that OxyContin should not be taken more than twice daily, when asked to explain why he had dispensed 2,664 tablets to one patient over a 14-month period.

The original Tribunal found this to be “an ill-considered attempt to justify what was plainly his dispensing of excessive quantities”.

The April 2021 hearing heard that the pharmacist, required to dispose of his financial interest in his store, sold it to a family friend – who then sold it in 2018 to the pharmacist’s son, who had just obtained registration.

He had returned to work there as an “unpaid part-time assistant” and said he had no role in dispensing medicines.

“He claims that when asked by former customers why he is no longer dispensing drugs, he says that he has stepped down to make way for the younger generation,” the Tribunal noted.

“He denied acting as the de facto owner of the pharmacy.”

The pharmacist said he acknowledged his “terrible and sustained mistakes” and undertook never to repeat them.

He said he had undertaken significant CPD in excess of that required of him, and to have read widely on the topic of substance abuse.

But the Tribunal observed that his behaviour had been “of a dishonest nature, motivated by greed” and said that the man faced significant hurdles to re-entering the profession.

“One of the very reasons that pharmacists are trusted to dispense scheduled medications like OxyContin is that they may be presumed to recognise suspicious use of prescription drugs when it forms a pattern, such was the case here, and take appropriate steps to protect the public from such abuse,” it said in making its decision.

“At best, [the pharmacist] turned a blind eye to obviously suspicious behaviour on the part of the ‘patient’ who collected the drugs, thereby failing in his duty to the public and his profession.

“His excuse of being under stress when he behaved so unprofessionally gives us no confidence that, placed under pressure again, and forced to choose between self-interest and the public interest, his judgment would be any better.”

It said he had not proven that he was fit to practise as a pharmacist, and dismissed the application.

It ordered the pharmacist to pay the HCCC’s costs of $8,300.

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