Potentially serious drug interactions involving behind-the-counter medications could be slipping through the cracks at pharmacy counters because staff aren’t thorough enough in their interactions with customers, a CBC News/Marketplace investigation has found.
The investigation, which looked at 50 pharmacies across the country including 10 in Quebec, found that many pharmacy employees didn’t ask enough questions or give proper instructions when dispensing behind-the-counter drugs and supplements.
Testers went into the pharmacies in nine Canadian cities and asked for Schedule 2 drugs, including Tylenol No. 1 and the iron supplement Palafer.
Schedule 2 drugs don’t require a prescription. They are kept behind the counter because pharmacists are supposed to counsel people who ask for it, according to guidelines set by various Colleges of Pharmacists across the country.
What the testers found was that fewer than half of the pharmacy workers provided that counselling.
Not a single pharmacy worker caught potentially serious drug interactions.
Questions not asked
CBC Montreal’s Alex Leduc went to six pharmacies in Montreal in one day with a hidden camera. CBC testers also went to four other pharmacies in Gatineau.
In all of the tests across the country, CBC journalists offered only the information requested by the pharmacy worker, including details on why they were taking the medication and what other medications they were also taking.
At four pharmacies, Leduc asked for Tylenol No. 1, which includes codeine, an addictive narcotic that can interact with other drugs.
If asked what other medications he was taking, Leduc said he was also taking Xanax, which can increase the effects of codeine.
At two other pharmacies, he requested the iron supplement Palafer. If asked, he said he was also taking the antibiotic Cipro. Palafer blocks antibiotics and pharmacists should instruct patients not to take the two medications in combination.
In Gatineau, testers followed the same methodology, but testers only asked for the Tylenol.
At the 10 Quebec pharmacies, staff at nine asked for the customer’s name and contact information, six provided counselling on the safe use of the medication, but none flagged the potentially serious drug interactions.
“What we found surprising is just how much of these drugs we could buy in one day, and how often pharmacists didn't ask us the questions, or give us the instructions, they should be,” Leduc said.
At one pharmacy in Montreal’s Southwest borough, Leduc asked the person working behind the counter for iron supplements.
The staff member only asked how much he wanted and didn’t request any of his personal information.
At another pharmacy in Côte-Saint-Luc, he told the staff member he was taking Cipro, but was given the iron supplements anyway and not cautioned about the possible interaction.
‘No place for bad apples’
The Canadian Pharmacists Association says the findings of the CBC investigation don't represent pharmacists’ general practice.
"Pharmacists continue to endeavor to provide high quality patient care and patient outcomes,” said Jane Farnham, president of the Canadian Pharmacists Association.
“I'm not going to comment on specific isolated incidents."
But in Quebec, the head of the province's order of pharmacists said CBC’s findings show there's work to be done.
“There is no place for bad apples,” Bertrand Bolduc, president of the Quebec Order of Pharmacists, said.
“If there are people who are not doing their job the right way, we're gonna make sure that it’s going to be corrected.”
Bolduc said it also highlights the importance of the full implementation of the Quebec Health Record (QHR), a provincial database for medical professionals that, in Leduc’s case, would have shown he had already purchased several iron supplements at different pharmacies that day.
The QHR was announced by the provincial government in February 2012 and its roll out was expected to take 12 months.
As of Jan. 9, 1505 of the provinces’ 1872 pharmacies had access to patient records through the QHR.
The Marketplace investigation, Dispensing Danger, airs Friday, January 23 at 8 p.m. (8:30 p.m. NT) on CBC Television and online.
Follow Marketplace’s continuing coverage of this investigation all week on cbcnews.ca.