This is a reader question relating to veterinary consultant Mark Opperman’s story “Are drugs leaving your practice the wrong way?” from the March 2014 issue of Veterinary Economics. Opperman responds on the next page.
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I just read your article on better drug control. It couldn't have come at a better time as I am having an issue at my job with missing buprenorphine. I have been an LVT for 26 years and am in charge of the controlled drug log. Every few bottles, I seem to be missing about 2 cc from a 10 cc bottle. I have changed to only putting 5 cc in a sterile bottle at a time and just noticed today that another 2 cc is missing.
We have several locked safes. I print usage information from the computer, check individual charts, and have a written sheet on all controlled drugs used. We also print labels that go into a drug log to keep a running total. We also have cameras in most, but not all, areas of the hospital. I am currently at a loss as to what else to do.
I reported this to my boss recently, but he’s a very trusting individual and I fear my suspicion and gut instinct is not going to be a popular choice at all (a new veterinary associate). My boss didn’t ask, and I don't have enough proof yet to accuse anyone, but I am keeping a list in my home of comments made by this individual regarding drugs, dates, amounts missing and bottle numbers. This is obviously getting past my triple-check system, and I'm beyond thinking it could possibly be an accounting error.
I have no idea what a human would do with buprenorphine, how much they would take or how they would take it. I am deeply concerned at this point, especially when the head veterinarian casually mentioned possibly making a spreadsheet to keep better track, and the individual in question volunteered to be the one to do it and then asked for access to my logbook. Do you have any suggestions?
Thank you for your time and your timely article.
I am very sorry to hear about your situation, but you have no idea how common a problem this is in our profession. It sounds like you are doing most of the things I would recommend under normal situations to control your controlled drugs, but your situation is not normal. I would now suggest you change the combinations on the safes and keep your buprenorphine in one of those safes. Only one person per shift should have the combination to that safe, and I would make sure there’s a camera pointed at that safe. Then keep an eye on the usage daily. That should help you narrow down who the culprit is.
As the person in charge of the controlled drugs, you have a responsibility to keep the practice owner informed of what’s going on, regardless of how he responds to it.
I would not keep any of this information or evidence at home, but instead at the practice, under lock and key. I would also suggest you keep a written record of your communication with the practice owner and what you have been doing about the situation.You should know that buprenorphine is used to help addicts through withdrawal and has significant street value. A 2008 article from the Baltimore Sun “ … in a study [from the company that sells Buprenex, the brand name for buprenorphine], its consultants found that half of the doctors they surveyed were aware of an illegal trade in buprenorphine and that their numbers have been climbing. The study concluded that ‘it was the patients in treatment for opioid abuse—no doubt selling or trading their own supply of buprenorphine—who were seen as major contributors to the street supply.”
In addition to the safeguards I mentioned in my article and above, I suggest you contact the U.S. Drug Enforcement Administration (DEA) and your local police to inform them about the situation. I would not delegate the responsibility of monitoring the controlled drugs to anyone else in the practice. This is a very serious issue and the source needs to be tracked down.
To report significant amounts of controlled substance theft or loss to the DEA, you can visit this website.
I wish you well. Please let me know if I can be of any further help or assistance to you,
Mark Opperman, CVPM
Veterinary Management Consultation