This guide begins by describing the problem of pharmacy robbery and reviewing factors that increase its risks. It then identifies a series of questions to help you analyze your local pharmacy robbery problem. Finally, it reviews responses to the problem and what is known about them from evaluative research and police practice.
For the purposes of this guide, pharmacy robbery, which falls under the broader heading of pharmaceutical diversion, is defined as the theft by force—or threat of use of force—of prescription drugs for personal use or profit. This definition excludes theft, burglary, backdoor pharmacies,† and illegal importation or distribution of prescription drugs. The related issue of prescription drug diversion is covered in a companion Problem-Oriented Policing guide, Prescription Drug Fraud and Misuse.
† “Backdoor pharmacies” are businesses not licensed or authorized to distribute pharmaceutical drugs.
What This Guide Does and Does Not Cover
Pharmacy robbery is but one aspect of the larger set of problems related to the unlawful use of controlled substances and the substance use disorder that often accompanies it. This guide is limited to addressing the particular problem associated with pharmacy robbery. Related problems not directly addressed in this guide and requiring separate analyses include the following:
- Theft from pharmacies, hospitals, and doctors’ offices. Pharmacy workers and healthcare providers, both of whom have easy access to prescription drugs, sometimes steal them, as do patients and relatives of patients who may have access to drugs because of proximity and poor security procedures.
- Burglary. Individuals obtain prescription drugs by burglarizing homes, doctors’ offices, and pharmacies.
- Medicaid fraud. Pharmacy workers sometimes commit Medicaid fraud, usually by substituting generic drugs for name brands, short-counting pills, or filling prescriptions without a refill and then overbilling Medicaid. They may also bill Medicaid for drugs they never dispensed.1
- Over-the-counter (OTC) drug misuse. Those who purchase OTC drugs to achieve a high are typically youth seeking cough and cold medicines, sleep aids, antihistamines, and anti-nausea agents.2 It is not known to what extent the misuse of OTC drugs increases the risk for prescription drug-related crimes, such as fraud, theft, or pharmacy burglary.
Pharmacy robbery is related to the larger set of problems associated with misuse of prescription drugs and robbery of retail establishments. Related problems, some of which are covered by other Problem-Oriented Guides for Police, include the following:
- Robbery of convenience stores
- Prescription drug fraud and misuse
- Drug dealing in open-air drug markets
- Drug dealing in privately owned apartment complexes
- Marijuana growing operations
- Rave parties
- Clandestine methamphetamine labs
- Mobile drug dealing
- Drug-impaired driving
- Bank robbery
For the most up-to-date listing of current and future guides, see www.popcenter.org.
General Description of the Problem
Pharmacy robbery is a serious and growing problem. According to the U.S. Drug Enforcement Agency (DEA), robberies of pharmacies in the United States increased 82 percent from 2006 to 2011.3 Overall, 3,535 pharmacies were robbed during that six-year period.4 The problem of pharmacy robbery is not unique to the United States: serious pharmacy robbery problems have been documented in England, Ireland, and Australia.5 While the problem is widespread internationally, it is also unique locally, with some regions and localities more susceptible to pharmacy robberies than others. In New York state, for example, pharmacy robberies increased from just 4 in 2006 to 30 in 2010.6 The common theme across international, national, and regional experiences with pharmacy robbery is that the volume of legally prescribed pain relievers has risen steadily. For example, opiate painkillers, arguably the most addictive of prescribed medicines, are also the most widely abused,7 and the distribution of these drugs has increased by over 600 percent in recent years.‡
‡ The rate of prescription opioids distributed by drug companies, as measured by milligrams per person, increased from 98 milligrams per person in 1997 to 698 milligrams per person in 2007 (CDC 2011).
Harms Caused by Pharmacy Robbery
Pharmacy robberies are acts of violence. As such, they pose a serious threat to employees and customers present at the scene, as well as to responding officers. As with any robbery, the violence associated with it can quickly turn lethal, as was the case on June 19, 2011, when four victims—a pharmacist, a clerk, and two customers—were shot and killed by two suspects in the course of the robbery of a Long Island, New York, pharmacy.8
Pharmacy robberies for the purpose of obtaining prescription drugs can cause untold harm, because the consumption and distribution of the drugs can progress into chronic substance use disorders and lead to further crime, overdoses, and even death. Indeed, deaths from overdoses of prescription drugs have risen dramatically in recent years.9 Pharmacy robberies also harm businesses, as some businesses have resorted to limiting the supply of heavily sought-after drugs such as oxycodone in order to prevent robberies.10 This restriction of medication that is critical for palliative care creates challenges for law-abiding citizens, who are unable to obtain legally prescribed medications to manage their chronic pain. As you contemplate how to approach the problem and impact of pharmacy robbery, you should carefully consider these types of harms and the contexts in which they may play a leading role in crime control and prevention role versus other contexts in which they may play a secondary, or referral, role. In the context of pharmacy robberies, secondary roles might include treatment providers to aid those who commit robberies because of their opioid use disorder.
Factors Contributing to Pharmacy Robbery
Understanding the factors that contribute to pharmacy robbery will help you frame your own local analysis questions, determine good effectiveness measures, recognize key intervention points, and select appropriate responses.
Misuse of Prescription Drugs and Opioid Use Disorders
Prescription drug misuse is significant and rising rapidly, with some observing that it is the nation’s fastest-growing drug problem. In 2010, about one in four illicit-drug users reported that their initiation into illegal drug use began with prescription drugs.11 This amounts to 2 million Americans over the age of 12 who illegally used pain relievers for the first time in 2010 alone.12
Overall, the most commonly misused prescription drugs fall within the class of controlled substances termed opioid pain relievers, such as hydrocodone and oxycodone. The prescription drugs that police agencies most frequently report as commonly misused include Vicodin® (hydrocodone), OxyContin® (oxycodone), Lorcet®, Dilaudid®, Percocet®, Soma®, Darvocet®, and morphine. Many of these top the list of prescription drugs used nonmedically by youth and young adults, who tend to favor pain relievers such as codeine, methadone, Demerol® (meperidine), Percocet, Vicodin, and OxyContin.
Many experts attribute the growth in prescription drug misuse and related crimes such as pharmacy robbery in part to the introduction in the mid-1990s of OxyContin, an oral, controlled-release form of oxycodone that acts for 12 hours. Oral oxycodone is a very effective pain reliever. However, when injected or snorted, users experience a rapid onset of euphoria. People who misuse opioids often obtain them through a legitimate prescription to treat pain or a medical condition. In this case misuse may constitute taking more than prescribed.
Such misuse of prescription drugs can progress into an opioid use disorder, which in turn can lead to criminal acts such as thefts, burglaries, or robberies to obtain cash for the purchase of such drugs or to obtain drugs directly. Moreover, this disease drives demand, making pharmacy robbery and burglary a lucrative business for those intent on selling the stolen drugs on the black market. Estimates of the street price of oxycodone run as high as $80 per pill.13
Other Illicit Crime and Drug Use
While scant research exists on the relationship between other criminal acts that are not driven by substance use disorder or pharmacy robbery, a national survey has identified a link between prescription drug misuse and opioid use disorders (prescription drugs and heroin), with those who reported illegally using prescription drugs 19 times more likely to begin using heroin.14 Moreover, a study of male and female burglars demonstrates the link between various forms of burglary and both heroin and prescription drug misuse.15
Pharmacy Management Practices and Design
While opioid use disorders and the profits sought from the illegal acquisition of prescription drugs may explain the impetus for pharmacy robberies, pharmacies themselves may create the conditions ripe for criminal opportunities. As other POP guides on convenience store and bank robberies indicate, not all retail establishments present equal opportunities for crime.§ Pharmacies that have sought-after drugs, such as opioids, for sale will be more desirable targets than those that do not. Likewise, the geographic location of the pharmacy, its management practices (hours of operation, number of pharmacists and cashiers on duty, and use of cash drop boxes), and its physical design may all
contribute to victimization.