CVS Lost More Controlled Substance Doses Last Year Than All Other Mass. Pharmacies Combined

Nearly 7,000 doses of controlled substances went missing last year from CVS stores in Massachusetts — almost 70% of all drug doses lost by Massachusetts pharmacies last year, according to records obtained from the Massachusetts Board of Registration in Pharmacy.

CVS is the largest pharmacy chain in the state; Walgreens, its next largest competitor, lost about 1,300 doses from its pharmacies last year. In all, more than 10,000 doses of controlled substances went missing from all Massachusetts pharmacies in 2020.

The missing controlled substances from the CVS stores include oxycodone (brand name: OxyContin), amphetamine (Adderall), methylphenidate (Ritalin), morphine (Roxanol), methadone (Dolophine) and fentanyl (Abstral), all of which are extremely addictive. The missing controlled substances from the Walgreens stores include most of the same drugs.

“Anything more than zero is too much,” said Dr. Manuel Pacheco, a psychiatrist specializing in addiction psychiatry at Tufts Medical Center in Boston.

The lost — or stolen — pills can be extremely lucrative. The street prices of these drugs are significantly higher than what they go for in a pharmacy. One fentanyl patch, for example, purchased from the local pharmacy will cost $9.40; from a local drug pusher it’s $40. OxyContin dispensed at a pharmacy runs $6.50 a tablet; on the street, $15 apiece.

But Pacheco said lost pills are not the primary way people illegally obtain medications.

Pharmacies are required to adhere to rigorous procedures for keeping track of controlled substances, such as maintaining a perpetual inventory of the most addictive controlled substances, which include oxycodone and morphine. Yet the disciplinary reports from the pharmacy board reveal that in most cases CVS and Walgreens had no idea how the drugs vanished from their shelves.

A CVS spokesman said the loss of 7,000 doses of controlled substances at CVS stores is not a major problem.

“We have stringent policies and procedures in place to help prevent the loss of controlled substances, as well as to help detect it when it occurs,” CVS spokesman Michael DeAngelis said. “Drug diversion is typically discovered through our own internal processes and investigations. ... We operate well over 400 pharmacies in Massachusetts.” Compared to other pharmacies, he said, “the number of controlled substance loss incidents we had last year was extremely low.”

CVS lost an average of 16 pills for each of its 420 stores in Massachusetts, while Walgreens lost an average of about 5 for each of its 245 stores. DeAngelis did not respond to follow-up inquiries about the disparity.

A Walgreens company spokesman declined to comment.

When Todd Brown, vice chairman of the Department of Pharmacy and Health Systems Sciences at the Northeastern University School of Pharmacy, was told of the large amount of missing controlled substances at a Massachusetts chain pharmacy, he said. “I know who it is — it’s CVS.”

“Historically, CVS has had a problem with missing controlled substances for some time now,” Brown said. “I don’t know why they can’t figure out a way to rectify everything. It’s not that complicated. The fact that you’re seeing one company continually having these issues means that they’re not exercising proper control. They’re simply treating the losses as a cost of doing business.”

CVS stores have been cited by the state pharmacy board for many years for the loss of controlled substances — ranging from five times in 2017 to 19 times in 2020. And Massachusetts is not the only place where CVS has had problems losing controlled substances. In New York, for example, CVS had to pay the federal government $1.5 million in 2018 after an investigation determined that the company failed to report the loss of controlled substances. In California, CVS shelled out $5 million in 2017 to the feds for various violations, including the loss of controlled substances.

John Burke, the president of Pharmaceutical Diversion Education in Ohio, said that the pharmacy board needs to get tough with pharmacies where controlled substances are disappearing.

“They need to clamp down hard by ramping up the penalties,” he said. “If I were running the board, I would call in the most senior pharmacy executive in the company and say, ‘Listen, here’s what you’ve done and not done. You’ve got to change this or there’s going to be drastic measures taken, even going so far as suspending the privilege of dispensing drugs.’”

Northeastern’s Brown also said that CVS is chronically understaffed, which often contributes to the loss of controlled substances. “Understaffing allows individuals to divert medications more easily because the rest of the staff in the pharmacy is busy trying to get everything done,” he said.

The pharmacy board has a wide range of punitive options available that it can impose on pharmacies and pharmacy personnel who commit controlled substance violations, including reprimands, censures, suspensions, revocations, probations, advisory letters and fines.

Of the board’s 70 total disciplinary and related actions against pharmacies, pharmacists and pharmacy technicians in 2020, more than half involved CVS and Walgreens, including

• Nineteen CVS and 15 Walgreens stores that were issued reprimands, put on probation, or given stayed probation;
• One CVS pharmacist who voluntarily surrendered his license;
• Four CVS and three Walgreens pharmacy technicians whose licenses were revoked or voluntarily surrendered.

The executive director of the state pharmacy board, David Sencabaugh, refused multiple requests for an interview through a spokeswoman.

Some CVS and Walgreens stores were repeat offenders. CVS stores located in Natick and Northampton, for example, were both cited twice last year for the loss of controlled substances, as were the Walgreens stores in Attleboro and Beverly.

Not all pharmacy chains have the same degree of losses in the state. Stop & Shop, which has 83 pharmacies in Massachusetts, lost 550 units of controlled substances in 2020, while Rite Aid, with 10 stores here, lost 61 doses. The 48 Walmart stores in Massachusetts did not lose any controlled substances.

Of the 240 independent pharmacies in Massachusetts, two — Apothecare in Brockton and Preferred Pharmacy Solutions in Haverhill — were cited by the pharmacy board for controlled substances violations.

Burke, the expert on drug diversion, says it may be time to get tough not just with the pharmacies where the controlled substances go missing, but with the board itself. “Maybe the pharmacy board members themselves don’t take the losses seriously enough,” he said. “If that’s the case, then you need to find the right people who will take it seriously.”

Colman M. Herman is a Boston-based freelance reporter.