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A Toronto doctor was sentenced to 12 years in prison on Thursday for his role in a fentanyl patch trafficking ring involving a pharmacist and dealers who struggled with their own opioid addictions.

Ontario Superior Court Justice Joseph Di Luca sentenced Dr. George Otto in a ruling delivered at an Oshawa courtroom on Thursday.

“A doctor, sworn by oath to help save lives, participated in a scheme that ultimately put many lives at risk. This tragic irony is made all the more acute when one considers that greed is the only apparent motive,” Di Luca said.

“Dr. Otto’s fall from grace is, in a word, staggering.”

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In June, a jury convicted Otto of one count of fentanyl trafficking. Court documents suggest that he received $1,500 in “commission” for each prescription he wrote from his family practice in North York, although it’s unclear if he was paid for every prescription.

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Di Luca said Otto lived in a “small mansion” that was subjected to a “significant mortgage” and had recently been refinanced. He also owed a significant debt to the Canada Revenue Agency.

“It is clear that he could not support his lifestyle and rather than change his lifestyle to address his financial predicament, he participated in the trafficking scheme.”

The 61-year-old was originally charged in 2016 by the York Regional Police in its investigation and takedown of the fentanyl trafficking operation. Six others were charged at the time, including pharmacist Shereen El Azrak.

The sentencing document states that Otto trafficked approximately 4,000 fentanyl patches from 2015 to 2016.

One young man, Liridon Imerovik, would obtain names for Otto, who would write false fentanyl prescriptions that would be filled by El Azrak, according to court documents. Imerovik and a man from Sudbury, Sean Holmes, would sell the patches.

Di Luca said that the trafficking scheme seems to have been in operation prior to Otto’s involvement.

Imerovik, now in his late 20s, pleaded guilty to trafficking hundreds of fentanyl patches and was sentenced this year to three concurrent sentences of nearly six years in a minimum-security jail.

READ MORE: Inside an Ontario fentanyl trafficking ring involving a doctor and a pharmacist

Holmes, who had faced other drug offences in the past and struggled with opioid addiction, also pleaded guilty to his role in the operation in 2017 when he was 33 and was sentenced to 77 months in jail.

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El Azrak, the pharmacist, had a trial by judge who, in 2018, found her guilty of fentanyl trafficking and possession for the purpose of trafficking. Her brother and co-accused was acquitted of those charges.

In October, El Azrak was sentenced to 13 years in jail. The Crown had sought between 11 and 14 years.

“Shereen is not an addict. Her only apparent motivation was greed,” Justice Chris de Sa said in that decision. “As a pharmacist, she would have also been aware of the deadly effects of this drug in the hands of addicts.”

The Ontario College of Pharmacists has placed El Azrak under an interim suspension.

Two others alleged to be involved in the scheme had their charges withdrawn.

According to the College of Physicians and Surgeons of Ontario, the regulatory body for medical doctors in the province, Otto, a McMaster University graduate, had not renewed his membership as of March. He had previously faced other disciplinary proceedings dating back to 2012.

Di Luca said Otto is married with four children, with the two youngest in elementary school. He had no criminal record.

Supporting letters provided at his sentencing hearing described Otto as someone involved with his church who was known for donating his time and money to those in need.

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“There is no doubt that his conviction and incarceration will have significant impact on him personally and on his family. It is almost certain that he will never practise medicine again,” Di Luca said.

READ MORE: More doctors are prescribing opioids to prevent their patients from dying of overdoses

In the years since the dismantling of this trafficking operation, the overdose crisis across North America has largely been fuelled by the tainted street supply, as opposed to prescription opioids.

Health experts and harm reduction advocates are calling for better access to prescription opioids for people with addictions in order to keep them away from the potentially deadly and unpredictable illicit supply. A doctor in Vancouver has been prescribing fentanyl patches to a handful of patients who have not had success with other types of substitution treatments. It’s part of a pilot program meant to help curb their reliance on illicit street drugs.