Healthcare Inspection – Administrative Summary – Opioid Purchases, VA Northern Indiana Health Care System, Marion, Indiana

OIG conducted an inspection to evaluate the merit of a concern submitted by the Drug Enforcement Administration (DEA) regarding the Marion Division of the VA Northern Indiana Health Care System (VANIHCS). The DEA reported a large opioid purchase increase by VANIHCS, Marion Division in fiscal year (FY) 2015 when compared to FY 2014 and to local Marion non-VA hospitals. We suspended our inspection. We decided to suspend the review because the Marion Division pharmacy purchases medications for patients in the Marion catchment area and for VANIHCS’s four community based outpatient clinics, and we determined that comparing the Marion Division pharmacy purchases to a local hospital’s pharmacy purchases was not an equal comparison to the population size or type served. Additionally, regulatory changes occurred in October 2014 that re-categorized hydrocodone from a Schedule III to a Schedule II drug that required the Marion Division pharmacy to begin purchasing and dispensing hydrocodone, which patients had previously obtained via mail order from a Consolidated Mail Outpatient Pharmacy. Therefore, it would be expected that the Marion Division pharmacy would be purchasing and dispensing larger numbers of opioid medications. The DEA did not have evidence of specific patient harm regarding opioid prescribing practices at the Marion Division, and our preliminary onsite interviews at the Marion Division did not reveal evidence of patient harm or drug diversion. We suspended our inspection after determining there was a rationale for the increase in purchases of hydrocodone at the Marion Division. We made no recommendations.