A British pharmacist has been suspended for 12 months and his wife given a warning after an internet pharmacy business was allowed to be “infiltrated by addicts” seeking Codeine Linctus.
David Paul Drury Nickels allowed “vastly excessive” amounts of codeine to be purchased over the internet, including by patients who were dependent on the drug, the General Pharmaceutical Council heard.
Nickels was the Superintendent Pharmacist of Drury’s Pharmacies Ltd, which operated two community pharmacies, a health centre pharmacy and an internet and mail order pharmacy business, MyPharmacy.co.uk.
The internet business was run from the upper floor of Drury’s Pharmacy in Newquay, Cornwall, where Nickels’ wife, Elizabeth, and another registered pharmacist worked sometimes as Responsible Pharmacist.
The online business catered only for non-prescription medicines.
The General Pharmaceutical Council heard that there were no specific standard operating procedures in place to regulate the internet business between 1 January and 11 November 2014 – and “no consistent or established practice of checking a customer’s previous purchase history before accepting a further order”.
Customers had the ability to record their health information, but were not obliged to do so.
After being tipped off about the online business, the GPhC had a staff member carry out test purchases. The staff member was able to purchase two 200mL bottles of Codeine Linctus on one occasion, and another two a week later, without recording any health information.
On November 11, Nickels, aware he was being investigated, emailed a GPhC inspector, Barry Cohen, to say he hoped the pharmacy had maintained its responsibilities to its customers.
“We continually audit all we do, we limit what people can purchase both in amount and frequency. We not only monitor names of patients, but also of addresses so that aliases cannot be used. You will be able to see all this in our SOP’s and other documentation…” he wrote.
The next day, Cohen arrived unannounced at Drury’s Pharmacy and was told by Nickels that the online service had become “infiltrated by addicts”.
“He said that they were alert to aliases and he drew attention to a blacklist of customers which was written on a whiteboard in the internet sales room,” the GPhC noted.
“Concerning Codeine Linctus, Mr Nickels said they sold up to two 200ml bottles at a time, because, at a dose of 5ml up to four times a day, two bottles would last two people ten days, and that customers could not re-order within ten days per bottle supplied.
“He said that around half of the pharmacy’s annual income, i.e. around £800,000, came from internet and mail order sales, and he estimated that Codeine Linctus sales comprised 10% to 20% of this.
“Of these, no more than three 200ml bottles per week were sold through Drury’s Pharmacy, and only one or two bottles were transferred each month to the health centre pharmacy.”
The online pharmacy’s sales had increased dramatically over the past 12 months.
The GPhC heard the cases of several patients, including one who persuaded Nickels to continue supplying her with large amounts of Codeine Linctus by telling him she would lose her job, house and children if he did not. She said she had spoken to her GP about the issue, and he did not follow this up.
Another used Codeine Linctus to cope with depression and family pressures and its ease of access allowed him to become increasingly dependent, he said. After his final order was cancelled he faced withdrawal.
This patient described a year of his life as “a blur” and said he had spent about £600 on the drug just at Drury’s Pharmacy.
The GPhC found that the lack of systems in place allowed many patients to obtain “vastly excessive” amounts of the drug.
Other patients were also supplied with excessive quantities of Solpadeine Max (paracetamol/codeine) and Paramol (paracetamol dihydrocodeine). Paramol was supplied unlawfully, as a script is needed for a supply of more than 100 tablets.
Nickels also admitted that he saw the online purchasers as “customers,” rather than “patients”.
“Mr Nickels wholly failed to deliver the same level of patient care as he would have provided at his bricks and mortar pharmacy,” the GPhC noted.
It found that he was principally motivated by the prospect of financial gain and he was suspended for 12 months.
Elizabeth Nickels said she had very little to do with the operating of the internet business until after the period scrutinised by the GPhC, when she took over as Superintendent Pharmacist. She only worked at the pharmacy occasionally.
However, a number of cases were highlighted where she could have intervened to stop sales – like the other pharmacist who worked there irregularly, Linda Helen Curgenven, who noticed orders she did not like, cancelled orders, and started restricting the quantities sold of certain medications.
Mrs Nickels agreed that she had also seen the online purchasers as customers, or “faceless patients”.
She was given a warning.