On a Wednesday afternoon this spring, with overcast skies and gas-slicked puddles on Utopia Parkway, some two hundred pharmacists gathered on the fourth floor of St. John’s University in Jamaica, Queens, for the Fifty-Fourth Annual Dr. Andrew J. Bartilucci Pharmacy Congress. The plainclothes professionals sat around tables draped with red tablecloths, sipping plastic cups of coffee and occasionally glancing at their phones.
At approximately two o’clock that afternoon, John P. Gilbride, Caucasian male, five foot six, medium build, clean-shaven, wearing a dark suit and glasses, entered a rear door of the room carrying a leather satchel. He stood with his head down before walking to the lectern and opening a PowerPoint presentation. Four massive bulls-eyes were splayed out on the conference room walls. “Pharmacy robberies and burglaries are taking place across the country at an alarming rate,” he said. “Do you talk about it? Do you prepare for it? We all had fire drills as kids. The same thing goes for pharmacy robberies.”
No one stirred. Gilbride talked as if he’d given the talk before. He flipped to a schematic of what appeared to be a Rite Aid in an anonymous Florida parking lot, notable only for its lack of “Twenty Percent Off” ads in the front windows. “The walls,” he said. “What are they made of? Is it easy for someone to cut a hole and break in from the gift shop next door?” He said he’d seen drugstores with netting installed in the drop ceiling. “It’s just an idea,” he said. “Just some things to think about.”
Gilbride, a former DEA agent, is employed by Purdue Pharma, LLC, the only drug manufacturer offering security training for law enforcement and pharmacists and the makers of one of the most commonly diverted drugs in America: OxyContin. Gilbride directs the company’s Law Enforcement Liaison and Education (L.E.L.E.) Unit, a privatized war against diversion (the industry term for using legal prescription drugs for non-medical or off-label purposes). As he talked, a few pharmacists unwrapped complimentary plastic-sealed L.E.L.E. folders, the covers emblazoned with the caduceus nestled inside the outline of a badge. Purdue’s informational brochures include, “How to Protect Your Practice.” An example of information provided: “Diverters have also masqueraded as government officials or as pharmaceutical representatives.” Sample tip: “Wipe counters and glass entry doors frequently to provide a fresh surface for fingerprints.”
The privatized war against drug diversion began nearly a decade after the FDA’s approval of a time-release oxycodone formula called OxyContin. The painkiller was approved for sales in December 1995, followed by an aggressive marketing campaign. (By 2000, the company had spent a reported $4.6 million for ads in medical journals, a sevenfold increase over four years. My father, a retired pharmacist, once had his photograph taken compliments of its “Partners in Pain” campaign.) The time-release formula was touted as practically addiction-proof, but the drug could also crushed and snorted, smoked, or injected. Some even blamed the explicit label warning not to do so for the abuse epidemic. Between 1997 and 2007, the estimated sales of all opioids went from 74 mg per person to 369 mg, a 402 percent increase. In 2008, the Centers for Disease Prevention and Control said prescription painkillers overdoses killed 15,000 Americans, a three-fold increase since 1999, a public health epidemic that outpaced deaths from gun violence.
In 2001, a decade before Gilbride left the DEA’s New York offices and joined Purdue, the agency launched its first-ever crackdown on a legal prescription drugs, going after Internet pharmacies, “pill mills” (stores masquerading as pain clinics), and perps who went “doctor shopping” (requesting prescriptions for the same drug from multiple doctors). The worst of the lot, as Gilbride tells it, exchanged sex for prescription or just sold prescriptions outright.
Something else happened at the same time and the story went something like this: A disabled Boston firefighter named Howard R. Moog Jr., who claimed his car had been broken into and his pills stolen, told police his doctor wouldn’t give him an additional prescription and so he robbed an Osco Drug store. (Estimates suggest there were 700 such robberies that year.) Two years later, Purdue launched a diversion task force and a national database called RxPATROL. (PATROL is an acronym for Pattern Analysis Tracking Robberies and Other Losses.) Nearly a decade later, Gilbride asked the audience in Queens. “How many of you have heard of it?” A dozen or so hands go up in the back of the room.
The number of pills stolen annually has reached an estimated 1.3 million. Over a single four-year span, 2006 to 2010, the D.E.A. said armed pharmacy robberies climbed 32 percent. On the day of the talk, the RxPatrol database had logged a sum total of 2,678 reported robberies. The average incident, in the words of one slide was: “A white (89%) male (92%), in their 20-30’s (78%), acting alone (86%), armed (78%), will enter the front door (95%) and leave through the front door (88%).” Usually, Gilbride said, the robber carried a gun. “One guy had a sword. Don’t ask me why. We laugh. But it could hurt.”
The site of his diversion talk in Jamaica (Exit 25 off the Long Island Expressway) is not far from where—if you’ll pardon the frankness—shit really hit the fan. In 2010, a single gunman killed four people, execution-style, inside Haven Drugs in Medford, New York (Exit 64). The following year, an off-duty federal agent from the Bureau of Alcohol, Tobacco, and Firearms was killed during a botched robbery at Charlie’s Family Pharmacy in Seaford, New York (Exit 44). Both incidents reportedly involved the theft of prescription pain pills. The day’s previous speaker, Joanne Hoffman Beechko, president of the Long Island Pharmacist’s Society (a practicing pharmacist who said she’d been robbed twice),z said ten percent of pharmacists she surveyed were now carrying guns.
Purdue made an estimated $2.8 billion on OxyContin in 2012, according to the healthcare research firm IMS Health. The company does not disclose its earnings and a spokesperson declined to say what percentage of its annual revenue go toward funding a private war on drug diversion. Gilbride said the company had hosted 240 training programs for law enforcement and health care professionals by the end of December 2012. Though OxyContin may be a drug practically synonymous with an epidemic, sales appear to be holding relatively steady. So, it appeared, were pharmacy robberies. Gilbride flashed a surveillance photo up on the walls for a few brief seconds. The image disappeared and he asked witnesses in the audience for a description.
“Good,” he said. “Do you work for DEA?”
“Could be a Glock,” Gilbride said. “This is a real pharmacy robbery. Who picked up on the gloves? A lot of people know that we’re telling people to wipe down the counters.” He went on. “When the cops show up, they’ll say, ‘What did he look like?’ You want to be able to say, ‘Grayish hair, glasses, five six.’ If you have a gun or a machete pointed at you, or a baseball bat, what you’re going to be staring at? The gun.”
A couple blurry surveillance photographs later, a red underline highlighted the following words in a Virginia police report: “The suspect had his face painted like a clown.” “I use this one,” Gilbride said, “because I love it.” One man in the audience stood up, wheeled around, and returned moments later, with a stack of RxPatrol-brand Height Reference Charts; the two-foot long stickers adhere to a pharmacy’s doorjamb to better catch a robber’s height on surveillance tape. “When the cops show up, they’ll say, ‘What did he look like?’ You’d say, short guy, glasses, short hair. But if you had a Height Reference Chart, he’d be five-six. It’s outstanding information for you to kindly use,” Gilbride said.
Purdue’s privatized war on diversion continued on multiple fronts: In 2010, the company released a tamper-resistant coating—a reformulation that made the pills more difficult to crush. (These “abuse-deterrent formulations,” one researcher wrote in the New England Journal of Medicine, “may not be the ‘magic bullets.’” When a legal opiate became less accessible, abuse drove an apparent increase in intravenous heroin use.) Purdue manufactured placebo OxyContin-80 for undercover operations and distributed tri-fold brochures to help police identify commonly abused prescription drugs; New York City police commissioner Ray Kelly announced the introduction of GPS-tracked decoy bottles that rattle with fake pills. The company declined to cite specifics, saying only: “We provide services to law enforcement.”
On April 15, 2013, Purdue’s original OxyContin patent expired; the same day, the FDA essentially sided with the company, prohibiting the sale of generic drugs, which, at the time, resembled the original formulation. In a statement, the agency said, “The benefits of original OxyContin no longer outweigh its risks.” Shirley Johnson, a company spokesperson told me, in a prepared statement (her emphasis), that the war on diversion would go on. “We feel that anti-abuse and diversion programs currently offered … will be needed more than ever if products that are not tamper-proof are on the market.”
Back in Queens, a hand shot up. A pharmacist wanted Gilbride to explain whether crackdowns on doctor shopping had fueled pharmacy robberies. “That’s a subjective question,” he said. “What’s causing that, I don’t know. What I can tell you is that they’re going up.” Another woman raised her hand and explained that her drugstore, a national chain she did not name, discouraged the use of a panic buttons. “I don’t know,” Gilbride said. “Sooner is better.” (Sample RxPatrol tip: Add extra panic buttons throughout store. Staff has better chance of activating alarm if they have more access points.) Another audience member wondered aloud about locking the front doors remotely. Someone else chimed in that armed robbers might then shoot their way out. A spontaneous conversation erupted. “What about revolving doors with bullet-proof glass?”
Gilbride shrugged. His refrain for the day: If you think about it just like a fire dill, you’re going to know what to do. These were all just ideas. “Which ones are better,” he said. “I couldn’t tell you.” No one could.