Loss or Theft of Controlled Substances Declared to Health Canada From 2014 to 2018: A Retrospective Study

AuthorTyler Morissette,Marc Parent,Pierre-Yves Tremblay,Pierre-André Dubé,Mélanie Tessier
DOI10.1177/00220426211017863
Date01 October 2021
Published date01 October 2021
Subject MatterArticles
2021, Vol. 51(4) 628 –647
https://doi.org/10.1177/00220426211017863
Journal of Drug Issues
© The Author(s) 2021
Article reuse guidelines:
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DOI: 10.1177/00220426211017863
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Article
Loss or Theft of Controlled
Substances Declared to Health
Canada From 2014 to 2018:
A Retrospective Study
Pierre-André Dubé1, Tyler Morissette1,
Mélanie Tessier1, Marc Parent2,
and Pierre-Yves Tremblay1
Abstract
Theft of prescription drugs is nothing new for Canadian pharmacists. Recently, an increasing
body of literature has covered the diversion of controlled substances from Canadian hospitals.
However, little has been published in the scientific literature concerning the data collected by
Health Canada’s Loss or Theft Report Program regulated under the Controlled Drugs and
Substances Act. Data from January 1, 2014, to December 31, 2018, were obtained from Health
Canada’s Office of Controlled Substances (OCS). Reports to the OCS are mostly provided
by pharmacies and hospitals, by veterinarian, dental, and physician clinics, pharmaceutical
distributors and producers, and federal establishments and organizations. Entries include
information related to the date, province, and location type; type of loss or theft; and generic
name of the product, its strength, dosage form, quantity, and drug identification number.
During the studied period, 45,379 submissions to the OCS provided information to create
213,895 entries to the database. After exclusions, 212,317 reports were retained for analysis.
Opioids count for 45% of reports, benzodiazepines for 29%, and psychostimulants for 21%.
Approximately, 29 million individual doses were lost or stolen of which 7.7 million were opioids
(26%), totalizing approximately 178 million oral morphine milligram equivalents with 95% having
been lost or stolen in community pharmacies. Moreover, approximately four out of 10 individual
doses lost in community pharmacies are unexplained losses, which represent about 4.6 million
individual doses. Reporting lost or stolen controlled substances and precursors is essential to
tracking the diversion of Canada’s prescription drugs. Pharmacists therefore have an important
role to play when it comes to minimizing their potential diversion. A better understanding of
the situation across Canada may help to increase health care professionals’ awareness, improve
practices, enhance the quality of collected data, and prevent further losses and thefts.
Keywords
prescription drug diversion, robbery, burglary, pilferage, community pharmacy, opioids
1Institut national de santé publique du Québec, Canada
2CHU de Québec – Université Laval, Canada
Corresponding Author:
Pierre-André Dubé, Institut national de santé publique du Québec, 945 avenue Wolfe, Québec, Québec,
Canada G1V 5B3.
Email: pierre-andre.dube@inspq.qc.ca
1017863
JODXXX10.1177/00220426211017863Journal of Drug IssuesDubé et al.
research-article2021
Dubé et al. 629
2 Journal of Drug Issues 00(0)
Background
Canada is facing a public health emergency. Between January 2016 and September 2020, more
than 20,700 Emergency Medical Services responses to opioid overdoses, 23,240 opioid-related
poisoning hospitalizations, and 19,355 apparent opioid toxicity deaths were reported across
Canada (Special Advisory Committee on the Epidemic of Opioid Overdoses, 2021). More is
done each day to inform Canadians (Government of Canada, 2021a) and to reduce the harms
associated with opioid consumption or abuse disorders (Busse et al., 2017; Canadian Research
Initiative on Substance Misuse [CRISM], 2018; Government of Canada, 2018, 2021b; Health
Canada, 2017, 2018c, 2019b). Although the Canadian government and its provinces and territo-
ries have taken steps to address multiple facets of this problem, little is known on diversion of
prescription opioids in the country although an increased trend has been reported (Fan, 2019; Fan
et al., 2020; Fischer & Argento, 2012; Reddon et al., 2018). Yet one of the main objectives of
prescription drug management programs (PDMPs) that are currently implemented is to reduce
diversion (Prescription Drug Monitoring Program Training and Technical Assistance Center
[PDMP TTAC], 2018). In February 2019, the Canadian Society of Hospital Pharmacists (CSHP,
2019) published guidelines for health care facilities concerning management and diversion pre-
vention of controlled drugs and substances. In May 2019, Health Canada also published a guid-
ance document on security, inventory reconciliation, and record-keeping for community
pharmacists (Health Canada, 2019c).
As required by Health Canada, loss or theft of controlled substances must be reported imme-
diately, within 72 hr, or within 10 days, depending on the substance (Health Canada, 2018b).
Health Canada’s Loss or Theft Report Program, regulated under the Controlled Drugs and
Substances Act, maintains an aggregated database of reported lost or stolen substances. These
substances include narcotics, controlled drugs, restricted drugs, benzodiazepines, targeted sub-
stances, and precursors (Health Canada, 2018b). Submissions to the Office of Controlled
Substances (OCS) are made by not only pharmacies and hospitals, but also veterinarian, dental,
and physician clinics; pharmaceutical distributors; and producers, federal establishments, and
organizations.
In February 2020, Fan et al. published an overview of opioid losses using Health Canada’s
data from January 2012 to September 2017 (Fan et al., 2020). Our study’s main objective is to
present a more comprehensive description of the current situation of losses and thefts of all con-
trolled substances in Canada.
Method
Data Collection
Anonymized data of reported lost or stolen controlled substances from January 1, 2014, to
December 31, 2018, were obtained from Health Canada. Data were provided in an Excel work-
sheet that included information related to the date of submission, submission identification num-
ber, province or territory, type of site (Canadian Forces Base, Correctional Facility, Dentist’s
Office, Emergency Medical Service, Federal Nursing Station, Licensed Dealer—Chemical
Precursors, Licensed or Registered Dealer, Hospital/Long-term Care, Pharmacy, Physician’s
Clinic, Royal Canadian Mounted Police, Veterinary Hospital/Clinic), type of loss (Breakage and
Spillage, Loss Unexplained, Manufacturer’s Shortage, Overages, Unusual Waste, and Other) or
theft (Armed Robbery, Break and Entry, Grab Theft, Impersonation, Pilferage, and Other), brand/
generic name or name of raw material, its strength, dosage form (capsule, liquid [in ml], patch,
and powder [in mg], sachet, suppository, and tablet), quantity, total amount (in mg) and drug
identification number (DIN). Based on a Canadian policy statement, evaluation by an ethics
committee was not required to conduct this study as the information is publicly available through

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