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It’s ‘just too easy’ for doctors to steal. That’s why opioids are vanishing by the fistful in B.C.’s Lower Mainland

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He just needed a little relief.

A decade ago, Michael was one of only three doctors on call in a remote community hospital in British Columbia. As a result, he had to be available pretty much all the time.

The vast majority of narcotics that have gone missing in recent years from Lower Mainland hospitals are attributed to three incidents in 2017 and 2018 at Vancouver General Hospital, where staff were found diverting opioids for years.
The vast majority of narcotics that have gone missing in recent years from Lower Mainland hospitals are attributed to three incidents in 2017 and 2018 at Vancouver General Hospital, where staff were found diverting opioids for years.  (Illustration by Perrin Grauer)

“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.”

Read more: ‘I was an impaired nurse’: Three nurses who battled addiction welcome dramatic shift in approach to discipline and treatment

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.

Between 2015 and April 2018, hospitals in the Lower Mainland reported more than 7,800 units of various narcotics went missing.
Between 2015 and April 2018, hospitals in the Lower Mainland reported more than 7,800 units of various narcotics went missing.  (Illustration by Perrin Grauer)

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's story also shows how easy it can be for a medical professional to become addicted. Statistics Canada says opioid addiction has killed more than 9,000 Canadians in the past three years.
Michael’s story also shows how easy it can be for a medical professional to become addicted. Statistics Canada says opioid addiction has killed more than 9,000 Canadians in the past three years.  (Illustration by Perrin Grauer)

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

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Anglais

Nostalgia and much more with Starburst XXXtreme

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline. 

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors. 

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity. 

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement. 

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level. 

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet. 

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Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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Anglais

MELS new major movie studio to be built in Montreal

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.

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