More than prescribed: 10-year restriction and $13K liability for giving patient excessive opioids

A Winnipeg pharmacist has been slapped with $13,000 in penalties and costs and banned for 10 years from serving as a pharmacy manager or preceptor after the College of Pharmacists of Manitoba found him guilty of five narcotics-related misconduct charges. Robert Nieman, who was co-owner and pharmacy manager of Health Plus Pharmacy until 2020, committed a range of offences that included dispensing narcotics in excess of the prescribers’ directions, failure to safely dispense, label and maintain an inventory log of ketamine powder, failure to maintain accurate inventory and theft and loss records of controlled substances, and breach of restrictions imposed on another pharmacist. The college investigator found that Nieman had disregarded a doctor’s dispensing directions and given more drugs than had been prescribed to a patient who was supposed to have been on a tapering regimen of opioid medications. After the patient consumed his supply of narcotics on the first day, Nieman switched from a prescribed regimen of one capsule three times a day to be dispensed Mondays, Wednesdays and Fridays to a daily schedule. Read: Health Canada launches portal to facilitate reporting loss and theft of controlled drugs and substances On one occasion, Nieman gave the patient 17 capsules of HydromorphContin instead of three, and at other times the patient got six or four capsules instead of three. The dispensing record for this patient did not show any written documents from the prescribing physician authorizing these changes. Nieman also delegated the ordering of narcotics to a pharmacist whom he knew had previously been disciplined by the college and whose practice restrictions include a ban on ordering and signing for controlled substances, according to the decision document issued by the college. The latter pharmacist, Shouren Bose, received a one-year suspension in July 2014 and was relicensed with a number of permanent restrictions. In addition to not being authorized to order controlled drugs, Bose is also not allowed to work alone in the dispensary. Yet a review of the pharmacy’s ordering system records found that Nieman had allowed Bose to log into the system using Nieman’s sign-in credentials and that, on 21 occasions when controlled drugs were purchased by the pharmacy, Bose was the only pharmacist present during those times. Read: Pharmacists should be allowed to continue offering opioid agonist therapy The college ruled that Neiman was at fault when his pharmacy failed to ensure the timely documentation of ketamine purchased from another pharmacy. In addition to letting more than a month lapse before logging this purchase into inventory, Nieman had allowed Bose—who was not allowed to order or sign for controlled substances—to pick up the ketamine from a compounding pharmacy and deliver it to the patient. Nieman stopped working as a pharmacist in January 2021. If and when he resumes his practice, he will not be able to assume the role of pharmacy manager or preceptor for 10 years. The college ordered to him to pay a $5,000 fine plus $8,000 towards investigation and hearing costs. Read: With melatonin supplement use on the rise, experts ask if it should be prescription-only

More than prescribed: 10-year restriction and $13K liability for giving patient excessive opioids

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