Nurofen Sabotage Exposes Lax Security, Loose Pills That Fuel the Pharmacy Business

The suspected spiking of packets of Nurofen Plus, a painkiller, with Seroquel XL and Neurontin ought to prompt an industry-wide investigation of security at pharmacies and drug wholesalers, the crime-infested ghettos of the pharmaceutical business. The sabotage is reminiscent of the Tylenol-cyanide murders of 1982 -- in which seven people were killed in Chicago after their medicine was spiked with poison -- one of the drug business's darkest hours.

Drug companies are proud of the measures they take to ensure the safety of their products at their manufacturing facilities. But once those pills are sold on to wholesalers and pharmacy chains, they enter a gray-market world of shoddy repackagers, middlemen who are equally happy dealing with stolen product or legitimate supplies, and pharmacy chains who have historically tolerated drug dealers.

This dubious underbelly of the pharma business is one suspected source of the sabotage of Reckitt Benckiser (RB.L)'s ibuprofen product, Nurofen, in Britain. The company says "sabotage" is suspected after "rogue" blister packs of AstraZeneca (AZN)'s antipsychotic Seroquel and Pfizer (PFE)'s anti-seizure drug Neurontin were found inside boxes labelled Nurofen. Two patients ended up taking the wrong drugs from four packets sold from London pharmacies and one from Northern Ireland.

Crucially, the sabotage involved "cut down blister" packs of Seroquel -- that is, blister packs of the Seroquel that had been cut smaller than their original manufacturing standard and fitted into the Nurofen boxes. Reckitt says:

The rogue Seroquel XL tablet cut-down blisters included parallel imported tablets (from two different PLPI companies) and originator product.

Cut-down blisters are common leftovers in pharmacies. When a patient's prescription calls for eight tablets but the standard blister pack has 10, the pharmacist may snip off two pills from the end of the pack. The spare pills are then shipped back to a repackaging wholesaler who may then resell the product to another pharmacy. Alternatively, the pharmacy may keep the spare pills and add them to someone else's scrip. Neither Reckitt, AZ nor Pfizer have any control over this process.

At Omnicare (OCR), a massive U.S.-based pharmacy benefit manager that specializes in supplying nursing homes, one whistleblower has alleged that workers were free to wander in and out of its repackaging facilities, the garage doors were frequently kept open, and its drug supply was completely cross-contaminated with penicillin.

The blame game
As Scotland Yard's Specialist Crime Directorate, which tackles organized crime, investigates, Reckitt and AZ have moved quickly to suggest that the mixup did not occur in their facilities (and that by implication it must be the wholesalers or the pharmacies), even though police have not reached that decision yet. Reckitt's statement said:

It is possible that these problems are linked to product consolidation and/or erroneous examination of returns.

Its PR agency added:

We are not ruling it out [sabotage at Reckitt] but we are considering other options as well. I think that is pretty unlikely."

AZ said:

Manufacturing errors by Reckitt Benckiser and AstraZeneca are not considered to be part of the cause at this stage.

(And, for good measure, the Daily Mail blamed animal rights activists even though Nurofen is not tested on animals and the paper didn't have a single named source offering any evidence for the accusation.)

The lot numbers on the packages and the locations in which they were dispensed will narrow down the locations through which the sabotaged packets travelled.

In the long run, however, whether the contamination occurred at the manufacturers, wholesalers, repackagers or the pharmacies is irrelevant. The Nurofen recall exposes the fact that pharmacies and repackers are rife with spare drugs from opened boxes, floating around in cut-down blisters. Until these companies get their "loose pills" problem under control, the supply chain will not be safe from saboteurs.

Related:

More from CBS News