VA Health Care:

Inadequate Controls over Addictive Drugs

HRD-91-101: Published: Jun 6, 1991. Publicly Released: Jun 19, 1991.

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Pursuant to a congressional request, GAO examined how Department of Veterans Affairs (VA) pharmacies controlled prescription drugs that were potentially addictive and assessed VA procedures for: (1) safeguarding those prescription drugs; and (2) detecting thefts of such drugs for personal use or resale.

GAO found that: (1) VA had inadequate internal controls over many addictive prescription drugs used in its health care system; (2) drugs were categorized, based on their potential for abuse or addiction, in one of five groups or schedules, with the lower schedules having the highest potential for abuse; (3) VA required its hospital directors to report thefts and significant losses of scheduled drugs to the Drug Enforcement Administration; (4) working stocks of lower scheduled drugs were at significant risk of theft, given the large numbers of pharmacy employees and others who routinely had access to the drugs; (5) of the nine pharmacies visited, only one locked up all lower scheduled drugs; (6) VA required each pharmacy to maintain an internal audit system that included unannounced inspections of higher scheduled drugs; (7) VA required pharmacies to maintain drug receipt and dispensing records and to make annual counts of all lower scheduled drugs, but did not require reconciliation of the records with the physical counts of those drugs; and (8) lack of inventory controls hampered theft detection and investigation, making it impossible to know the magnitude of lower scheduled drug losses.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA included this issue in its 1991 FMFIA report and published a circular addressing this issue. After additional review, GAO determined that the recommendation is being adequately implemented.

    Recommendation: The Secretary of Veterans Affairs should report inadequate internal controls over lower scheduled drugs as a material weakness in his 1991 Federal Managers' Financial Integrity Act (FMFIA) report. To address this weakness, the Secretary should direct pharmacy managers to store and dispense lower scheduled drugs in locked areas that are accessible to only a minimum number of authorized employees.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA included this issue in its 1991 FMFIA report and published a circular addressing this issue. VA has issued a new chapter in the VHA Manual M-2 "Clinical Affairs," which provides new requirements for lower-scheduled drugs, including periodic inventory inspections.

    Recommendation: The Secretary of Veterans Affairs should report inadequate internal controls over lower scheduled drugs as a material weakness in his 1991 Federal Managers' Financial Integrity Act report. To address this weakness, the Secretary should direct pharmacy managers to inspect supplies of lower scheduled drugs periodically, using receipt and dispensing records, so that potential drug losses are detected in a timely manner.

    Agency Affected: Department of Veterans Affairs

 

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