ROSEVILLE, Calif. — The U.S. Drug Enforcement Administration filed for an administrative inspection warrant this week to look into Kaiser Permanente’s pharmacy at Roseville Medical Center.
In an affidavit filed as part of the request, DEA investigator Brian Glaudel said this Kaiser pharmacy is the “highest purchaser of hydrocodone products within DEA’s San Francisco Field Division,” which stretches from Bakersfield up to the Oregon state line.
So far in 2019, the Roseville pharmacy has purchased nearly 1.3 million doses of hydrocodone, a painkiller containing a highly addictive and abused opioid pain reliever. That number is 250,000 doses higher than the second-highest purchaser of hydrocodone within the Division so far this year, Glaudel said. The pharmacy “is also the third highest purchaser of oxycodone products within the same region and time frame,” Glaudel said, of another addictive painkiller.
Additionally, this pharmacy has never been inspected by the DEA in the nearly 11 years it has been registered with the Administration. “As such, there is a valid public interest in the proposed administrative inspection because it will allow DEA to proceed with the effective enforcement of the (Controlled Substance Act),” Glaudel wrote.
Kaiser Permanente Northern California’s Vice President of Pharmacy Operations and Services, Kathryn R. Brown, Pharm.D./MHA, said there’s a perfectly good reason for these numbers.
“When discussing volume from any single pharmacy, an important thing to understand is that due to our integrated system – in which our members and patients primarily only use Kaiser Permanente pharmacies – our pharmacies can dispense many more prescriptions per location than most other local retail chain pharmacies, which are smaller and have far more locations in most communities,” Brown wrote in a statement sent to ABC10 News.
“In some communities, including Roseville, there can be dozens of retail chain and independent community pharmacies, and only a few Kaiser Permanente pharmacy locations,” she continued. “In fact, according to data from the National Community Pharmacist Association, total prescription volume at our Roseville pharmacy is more than 10 times the size of an average retail pharmacy, due to the number of Kaiser Permanente members who use it as their retail pharmacy pickup location.”
She added that Kaiser Permanente is working to get the DEA the information it's seeking.
“At this time, we are unaware of any specific compliance issues prompting the administrative inspection,” Brown wrote. “We remain committed, as always, to complying with all state and federal regulations and ensuring the safety of our patients and members.”
However, Glaudel is worried that patterns he’s seeing in this pharmacy’s sales of opioid-based painkillers could indicate drug diversion. That’s the medical and legal term used to describe when a legitimately prescribed drug gets ‘diverted’ to someone else, especially for illicit use.
In his affidavit, Glaudel said dispensing records for this pharmacy in a state database “revealed patterns that I recognized, based upon my training and experience, as potential red flags for diversion including, among other things, the filling of prescriptions for high dosages of controlled substance opioid painkillers for multiple patients for an extended period of time.”
He’s requesting the administrative inspection warrant to “verify the legitimacy of the controlled substances prescriptions,” he said.
Brown pointed to Kaiser Permanente’s work in the last decade to become a leader in the national effort for opioid safety.
“We have dramatically reduced our members’ risk for opioid abuse and addiction through improved prescribing policies, monitoring and follow-up processes, and coordination across departments and specialties,” Brown said. “From 2011-2017, we reduced the prescription of opioids across Kaiser Permanente members and patients by nearly 40%.”
Kaiser’s approach to reducing opioid dependency includes limiting opioid prescriptions and offering non-opioid pain management alternatives. The health system also encourages its doctors to “prescribe lower doses and shorter courses when opioids are medically necessary” and then help those patients wean off the drugs, if possible. Kaiser Permanente also provides drug disposal bins at many pharmacies and participates in drug take-back events.
“Our approach focuses both on prevention of opioid addiction upstream, as well as care to address opioid misuse and addiction,” Brown wrote. “Our integrated care delivery system and coordination make our opioid management program possible –– and successful. In our model, members, providers, hospitals, medical offices, pharmacies, and laboratories are linked together in one system. Physicians and care teams from our primary and specialty care, pain management, and addiction medicine departments work closely with each other and with our pharmacists –– to provide effective pain relief while limiting the risk for opioid-related complications.”
The warrant Glaudel is requesting is an administrative inspection warrant, much like an audit, and not a criminal search warrant. It would allow him to inspect and copy records such as inventories, reports, order forms, invoices, the list of employees with access to controlled substances and the list of patients who have signed an opioid contract.
“Any records reviewed, seized, and or copied will be kept confidential and maintained to ensure patient privacy,” the affidavit says.
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