When a man clutching a work order and a ladder walked into a Philadelphia-area pharmacy and told employees he had been dispatched to fix the lights, no one gave it a second thought.
It was only later that the pharmacy discovered the "workman" was a drug thief.
Pharmacies across the country are fighting a battle of wits with such thieves in an effort to safeguard the kind of potent, addictive painkilling drugs that were taken from two University of Maryland Medical Center pharmacies and led to a $250,000 federal fine that was announced Tuesday.
They're installing cameras, using software to track their inventory and reporting missing pills to national databases for analysis.
"There are several different methods, ways that drugs are lost," said Howard Schiff, executive director of the Maryland Pharmacists Association. They range from burglary to elaborate frauds.
While police, drug manufacturers and state regulators all offer advice, experts say the best way pharmacies can keep drug thieves and abusers at bay is common sense, and seeking a little help.
The Maryland Board of Pharmacy, for example, is backing a bill in the General Assembly to register pharmacy technicians, a way of tracking the few who steal from one pharmacy before moving on to another.
Johns Hopkins Hospital has installed a larger vault and a secure storage area for controlled substances, along with software that tracks what drugs are coming and going into the facility. And the University of Maryland Medical Center, whose unaccounted-for 7,900 doses of OxyContin was found in the hospital's 2001 audit, has agreed to take a variety of remedial measures, including hiring a medication security officer.
Nationally, many pharmacies now report drug thefts and frauds through a program called RxPATROL, sponsored by Purdue Pharma, OxyContin's manufacturer.
Capt. Richard Conklin of the Stamford, Conn., Police Department, moonlights as the program's overseer, using software on his home computer or one provided by the manufacturer to analyze patterns in the theft reports. When he spots one, he issues an alert.
Conklin informed others about the phony pharmacy electrician, who is still at large, in Philadelphia.
"Security film shows him stealing bottles of medication," Conklin said, adding he thinks the man stole hydrocodone, a popular target of theft sold under the brand names Vicodin, Lorcet and Lortab. "He just parlayed his way in."
Thieves use a variety of approaches, ranging from burglaries to smash-and grab-robberies to inside jobs in which employees pocket the pills.
Some thefts are sophisticated frauds in which pharmacists fill multiple phony prescriptions that they arrange for others to present.
Some desperate addicts "doctor shop," going to multiple doctors and pharmacies to get large quantities of the drugs for themselves.
"We get some burglary robbery cases out of Maryland," Conklin said yesterday. But Maryland is "definitely not one of the hotspots."
Baltimore has 45,000 to 50,000 illicit drug users, about 70 percent of whom take heroin, according to Dr. Peter L. Beilenson, the city health commissioner. Even so, he described prescription drug abuse as a "serious problem."
He has monitored prescription drug trafficking at Lexington Market, part of a coordinated crackdown on a drug bazaar that once flourished near the location of several addiction treatment programs.
While the issue is not new, statistics show prescription drug abuse appears to be increasing statewide and nationally among 18 to 25-year-olds.
The proportion of addicts abusing drugs in a prescription-laden category the state calls "other opiates" has been increasing steadily since 2001, according to information gathered by state-certified treatment programs.
The category includes OxyContin and five other prescription drugs, along with opium and other drugs with morphine-like effects.
Some 2,208 people, or 3.4 percent of enrollees in those programs, said they used one of the "other opiate" drugs in a fiscal 2001 survey. By last year, that proportion had grown steadily to 6.1 percent of 75,523 enrollees. Nationally, the number of young adults, aged 18 to 25, who illicitly used prescription drugs at least once grew 15 percent from 2002 to 2003, according to a Health and Human Services Department survey released last fall.
Although it gets plenty of media attention, OxyContin is not the most frequently abused painkiller, said Purdue Pharma spokesman Robin Hogen.
Overall, the number of people who reported illicit use of OxyContin rose from 1.9 million to 2.8 million between 2002 and 2003.
In contrast, nonmedical use of hydrocodone, another popular pain reliever, went from 4.5 million people to 5.7 million.
Jack H. Freedman, chief of the Maryland health department's drug control division, says he and four others inspect 1,200 to 1,300 pharmacies. While the division is supposed to do so annually, he says, understaffing means it doesn't happen.
Nobody knows what happened to the unaccounted-for drugs at the University of Maryland pharmacies, but Freedman and Drug Enforcement Agency officials say they were probably stolen.
That is why Freedman often recommends that pharmacists install cameras. Without them, "it's hard to prove sometimes who actually took something when there's a situation when there's more than one person who has access," he said.