“It was a small hospital, but it wouldn’t take much to make you busy,” Michael explained.

“If just one person came in with a stab wound requiring a chest drain and a hemothorax, that would make you busy. … One suicide attempt requiring (a patient) to go on the ventilator, that means you’re busy all night because there’s not a lot of other staff to help.”

At the same time, Michael’s marriage was beginning to fracture. Feeling he had little support to lean on, he started looking for a reprieve from the stress.

“I started taking capsules of various opiates that patients had given me over years and I had them just lying in my office,” Michael said. “I used them to sometimes give out to patients if they couldn’t afford them.”

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The drugs that were prescribed for patients but never taken — or drugs returned to him by family members of patients who died — should have been accounted for and destroyed with witnesses, as required by the Controlled Drugs and Substances Act. Instead, they were “diverted,” the term used by the medical community to describe theft of narcotics for personal use.

“It was just too easy,” Michael said. “They were just sitting in the cupboard.”

The doctor’s real name is not being used to protect him from potential legal trouble. The Star verified his standing with the B.C. College of Physicians, which lists his medical licence as temporarily inactive; he is now in his second attempt at recovery.

“It started foolishly,” said Michael. “I promised myself I wouldn’t become addicted, but I did.”

Michael’s past shows how easy it can be for a medical professional to become addicted — but also how easy it is to steal controlled narcotics without getting caught. No one would miss a couple of pills, he thought, and he was right.

More than three years after a Vancouver General Hospital aid died of an overdose, resulting in government promises to crack down on the theft of narcotics from hospitals, Health Canada documents obtained by the Star show the problem of missing drugs persists across the Lower Mainland.

Between 2015 and April 2018, the Health Canada documents show hospitals in the region reported more than 7,800 units of various narcotics missing.

Answers are few and far between — prosecutions even more so.

Most disappearances, nearly 85 per cent of the incidents on record, were categorized as “unexplained.” Of the few cases labelled “pilferage,” or staff theft, not one has been reported to police. In fact, only four per cent of all the drug disappearances were ever reported to law enforcement.

The vast majority of the missing units — about 5,000 — are attributed to three incidents in 2017 and 2018 at Vancouver General Hospital, where staff were found to have been stealing opioids for years.

Much of the rest came from St. Paul’s Hospital, where 600 vials of hydromorphone were “lost in transit” in 2015, and the Pharmacy Distribution Centre, where about 900 missing hydromorphone tablets were recorded as a tabulation error in 2017.

The figures, encompassing a jumble of different drugs, obscure the scale of the losses. When converted into a rough measurement called “milligrams of morphine equivalent” — a benchmark used to assess potency when patients are prescribed multiple drugs at once — those five cases at Vancouver General, St. Paul’s Hospital and the Pharmacy Distribution Centre represent a loss of 71,137 milligrams of morphine. That’s equivalent to 15,800 Tylenol 3 tablets or enough morphine to knock out 49 horses.

As shocking as the numbers are, pain-management expert Dr. Owen Williamson says they likely represent only a sliver of all the drugs that actually go missing.

“They may be the tip of the iceberg,” said Williamson, president of the Pain Medicine Physicians of B.C. Society. “There are just so many ways people can divert that stuff.”

Health Canada records won’t reflect how much is actually going missing, he said, because of the way drugs are tracked. Most tracking systems assume that drugs dispensed for a particular patient are actually received by that patient. That isn’t always the case.

In operating rooms, Williamson explained, it can be easy for staff to draw more liquid narcotic than necessary, swap it into a second syringe and take it home. He’s also seen cases of staff at nursing homes dispensing used fentanyl patches to patients and keeping the fresh ones for themselves.

“Wherever you have opioids, you’ll have people who are inventive at diverting it,” he said.

Kerri O’Keefe was one of those people. The 36-year-old hospital aid died in August 2015 after injecting an anesthesia drug she stole from Vancouver General — the end of a long pattern of theft.

As reported in the Vancouver Sun, which covered the case, the Ministry of Health responded by directing health authorities across B.C. to improve the security and tracking of pharmaceuticals.

In 2017, the provincial government announced $5 million in additional funding for the B.C. Centre on Substance Use for research on addictions care. Part of that funding went toward new hospital training and monitoring programs for drugs at risk of theft.

It’s unclear what effect these changes may have had, as acts of pilferage are rarely recorded as such.

The Health Canada records contain more than 250 cases, accounting for all of the drugs known to be missing from B.C.’s Lower Mainland. Only 12 of those cases were officially reported as pilferage.

In one case, a Ridge Meadows Hospital nurse in Maple Ridge found a box of morphine vials that had its bottom cut open. The vials had been emptied, and the package was resealed and stashed on a shelf behind other similar packages. The official cause was “unexplained.”

At Chilliwack General Hospital, nursing staff found a vial of fentanyl with a needle hole in the rubber plug. Though this was considered a “potential diversion situation,” it was recorded as “unexplained.”

Surrey Memorial Hospital experienced “multiple losses” of hydromorphone, oxycodone and morphine from the in-patient medical unit over the course of 18 days. All “unexplained.”

Each Health Canada record includes a section detailing steps the hospital plans to take to prevent future losses. Some of the losses resulted in changes to security procedures, like requiring double signatures on paperwork, changing locks, installing security cameras or switching to more secure automated dispensing machines.

At Langley Memorial Hospital, for example, a nurse was removed from the workplace after admitting to repeatedly slicing open blister packs of hydromorphone, stealing the drugs and replacing the capsules with an unknown substance.

However, just as many of the records do not spell out significant changes to security practices. Often the plan is for staff to be more vigilant.

An opioid diversion expert who reviewed the documents says important precautions that could prevent these thefts aren’t being followed, in large part because the losses are being misclassified as “unexplained.”

“It’s insane,” says John Burke, president of the U.S.-based International Health Facility Diversion Association. “Almost all of these indicated diversion … It’s horrific, in my opinion.”

After a career in policing, including a decade running the Cincinnati Police Department’s Pharmaceutical Diversion Squad, Burke retired and founded Pharmaceutical Diversion Education Inc., which provides education and consulting work on drug diversion for hospitals, law enforcement and the pharmaceutical industry.

Shown a copy of the Health Canada data, Burke said it’s clear to him the majority of these cases are not accounting errors or simple discrepancies.

“Guess what? Somebody’s stealing,” Burke said.

“Somebody diverting in this scenario, this is a smorgasbord for them. They’re going to realize that as long as they don’t get caught in the act, they’re probably going to be OK.”

In a statement, Health Canada said it collects these reports from all pharmacies across the country, including from private businesses and public hospitals. The department “evaluates reports on an aggregate basis to identify trends and identify patterns of diversion.”

For example: “This could include an assessment of which products are being reported as lost or stolen, in what frequency, and if there are geographic differences in reported diversion.”

If Health Canada detects a worrying trend, it may work with hospitals to determine the root cause. It does not conduct investigations and leaves the decision to report to police to individual hospitals.

But Michael’s case, which took place outside the Lower Mainland, illustrates a problem with this approach. The narcotics he diverted would never show up in Health Canada data because they were never recorded as a loss.

“They would not have been reported missing because they would have already been dispensed to a patient,” Michael explained.

Burke said that, based on his research in the U.S., those doing the thieving are careful to cover their tracks.

Some hospital patients will be given prescriptions for painkillers on an as-needed basis, like with morphine, for example. If a patient is in pain, they can request another dose that a nurse can administer without needing to go back to a doctor for a new prescription.

“So a nurse could go in and document that they gave a patient a shot (of morphine) when they really didn’t,” Burke explained.

“Or they can do what we call splitting a shot — giving half to the patient and half to themselves … None of those are going to show up (in the data) because they’re going to make it look like everything is kosher.”

Michael said he wasn’t anywhere near that devious. He said he never lied to his colleagues about his opioid use; he just wasn’t upfront about it.

As he began to realize he was addicted, he considered confiding in his colleagues — but doing so would have required them to report him to the B.C. College of Physicians or be put in legal jeopardy for keeping his secret.

Eventually, keeping that secret himself became too much.

“I needed to get some help,” Michael said. “It was getting to the point where things were just … it didn’t feel good. I used to dream about it. I felt terribly guilty. I just needed that monkey off my back.”

In 2011, he turned himself in to the college, which he said immediately suspended his licence and launched an investigation into whether his patients’ care had been compromised.

Michael said his opioid use was relatively light — a capsule in the morning and again in the evening — and that the college’s investigation found his patients had never been put at risk. The college itself would not comment on Michael’s case nor its investigation, citing privacy concerns.

But aside from protecting his patients, Michael said the college also protected him from himself, insisting he get a lawyer and connecting him with addictions treatment and supports. He went on leave, got into recovery and began working the Narcotics Anonymous steps, all with the backing of the college.

Michael said his case was never reported to the police.

Burke said that in the U.S. some hospitals actually have armed law-enforcement members as part of special opioid diversion teams. As he sees it, every instance of narcotics being stolen is a crime that should be reported to police.

But Michael questions that approach and the criminalization of addiction overall. Statistics Canada says opioid addiction has killed more than 9,000 Canadians in the past three years. For people like him, it is hard enough to come forward and seek treatment even without the threat of prosecution hanging above their heads.

The B.C. College of Physicians agrees.

“Most likely, if the college was made aware of a physician stealing narcotics for personal use, it would consider it a health matter rather than a disciplinary matter,” Susan Prins, director of communications, wrote in an emailed statement.

If a physician fails to comply with a treatment and monitoring plan laid out by the college, their status would remain “temporarily inactive,” Prins said. If they ultimately refused altogether, they would be considered for disciplinary charges and could ultimately lose their medical licence, though Prins said that has never happened in the history of the college.

“If the situation involves a theft, the decision to report to the police would be up to the victim of the theft, e.g. the clinic or health authority,” Prins wrote.

Records show that Vancouver Coastal Health (VCH), the health authority that reported the greatest losses, chose not to report any of the cases to the police — except one obvious smash-and-grab job not perpetrated by staff.

Stacy Sprague is the director of employee wellness for VCH. She said her organization takes roughly the same approach as the College of Physicians, preferring intervention over criminalization.

“We really do care about folks who are struggling with this,” Sprague said. “If people are diverting (narcotics), obviously there’s a lot going on there.”

Sprague said VCH uses a “health-care focused” program specially designed for working with people who are used to being caregivers, not someone in need of care.

That type of approach is what helped Michael. Recognizing it was OK to be both a doctor and a patient at the same time was difficult, he said, in part because society tends to put medical professionals on a pedestal.

“Anybody can fall victim to this,” he said. “There is no immunity. People who are addicted come from all walks of life. Physicians are the same as anybody else.”

Jesse Winter is an investigative reporter based in Vancouver. Follow him on Twitter: @jwints