Toronto's auditor general calls for crack down on Viagra, fentanyl prescriptions for city employees

The City of Toronto's auditor general is set to unveil recommendations after dozens of city employees were found to have been prescribed excessive quantities of drugs like oxycodone, Viagra and fentanyl.

The report from October 2016 revealed the city spent nearly $2 million on erectile dysfunction drugs, covered through drug benefit programs, in 2015.

It also found the city could recover nearly $750,000 by putting a $500 cap on erectile dysfunction pills. 

Beverly Romeo-Beehler, the auditor general, has several recommendations in her latest report, which laid the blame at the feet of both the doctors who over-prescribed the drugs, and city employees who may have taken advantage of the system.

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"Overall we did not find clear signs of double doctoring in the sampled claimants for prescription fentanyl patches and oxycodone claims," Jane Ying, assistant auditor general, said in a written statement to CBC News. 

But, she continued, "we noted many cases showing signs of potential over-prescription of fentanyl or oxycodone by physicians."

The auditor general has eight recommendations for the city, including: 

• Directing employees who may be addicted to employee assistance programs.
• Asking the insurance plan administrator to detect future problems.
• Following up with individual claimants and finding whether there was abuse of employee drug benefits.
• Closer examination of further problems in the future.
• Setting up new policies and procedures for exceptional prescription cases.

Ying pointed out several notable cases where it was highly unlikely that a city employee was using the benefits program properly. One such example includes:

• Between 2014 and 2015, one claimant was reimbursed for 942 tablets of Cialis, Viagra and Levitra at a total cost to the city of $13,500.

As for improper prescriptions listed in the report, 14 doctors were also found to have prescribed at least four times the recommended morphine dosage via fentanyl patches to nine non-cancer claimants. 

Dangers of over-prescription

It is not just erectile dysfunction pills being potentially abused, but other drugs including oxycodone and fentanyl.

The drugs most commonly over-prescribed in the report are also known to carry a high street value, leading to concerns that city employees, using city-paid drug benefit plans, have re-sold pills. 

Medical experts, like Dr. Peter Selby, warned in October that while it is important to control excessive amounts of drugs, there is also a balance to be made to ensure patients who need the medication are getting the help they need. 

"Find out if these people are actually addicted and need help, as opposed to simply cutting them off," Selby said. 

The auditor's committee is set to meet on June 27 to discuss the recommendations.

Since October, the city has changed its benefits administrator from Manulife to Green Shield Canada.