Approximately 10% of all healthcare workers will steal opioids and other substances from patients and hospitals at some time during their career, according to a national database that tracks drug diversion. This problem occurs across health systems of all sizes, all around the country. Fueled by the escalating crisis of opioid abuse, drug diversion has become a significant risk for healthcare organizations. The good news is automated software tools are playing an important role in prevention and detection. More on that later in this series. First, let’s look at the impacts, motivation and opportunities for diversion within the healthcare system.

Impact

Sometimes referred to as healthcare’s hidden epidemic, drug diversion is a multi-faceted problem that poses serious risks to patient safety. Drug diversion has led to infection outbreaks, caused patient suffering and resulted in deaths. For many health systems, failure to put effective controls in place has resulted in significant financial penalties, patient harm, and ultimately reputational damage.

Motivation

The types of drugs targeted for diversion vary depending upon whether healthcare workers are seeking drugs for their own use or to sell for profit. While opioids are the most commonly diverted drugs, they aren’t the only substance being misused in the healthcare setting. People who are diverting often begin with less potent Schedule III drugs and progress to stronger medications, including injectable narcotics. Workers intending to sell the diverted drugs are more likely to target brand-name oral medications with higher street value.

How drug diversion happens

In any medical system, many people have access to controlled substances. That group includes but is not limited to nurses, pharmacists, anesthesiologists and pharmacy technicians. Potential diverters include staff involved in procuring, preparing, dispensing, prescribing and administering drugs, as well as anyone disposing unused medications. At any of those points in the process medications can be diverted, and risk of drug diversion is heightened when the same person performs more than one of these functions:

• Ordering – Procurement teams include people who order, receive and pay for controlled substances. If the hospital system is not routinely reviewing ordering patterns and comparing the amount of drug purchased to the amount dispensed, an opportunity for diversion is present.
• Dispensing – Healthcare workers who prepare and dispense medications may pocket controlled substance vials or syringes substituting saline or some similar fluid for the actual drug.
• Prescribing – In addition to doctors who write prescriptions for themselves, other healthcare workers may have access to prescription pads that can be used to forge prescriptions. Diverters may alter verbal orders to increase the amount prescribed.
• Administering – Automated distribution devices are another potential point of access for healthcare workers intent on diverting drugs. For example, if use of automated distribution devices is not monitored, workers could withdraw medications on cabinet override for a patient who has already been transferred or discharged.
• Disposing – Expired or excess medication should be disposed of in a specific manner and in some cases a witness is required when disposing in a secured container. When these practices are not followed, healthcare workers can remove medication from the disposal container, possibly replacing it with another substance to avoid detection.

Combating the problem

What can be done to combat this problem? The first step is to recognize the reality that diversion of desirable drugs, including controlled substances and high-cost medications, is taking place in most healthcare systems. Healthcare facilities need controls to identify and prevent drug diversion, and resolve instances when diversion is suspected to be occurring. Technology plays an important role in prevention and detection. The next blog in this series will examine steps hospitals are taking to clamp down the risk of drug diversion.

About the Author

Patrick developed a passion for innovation re-engineering bicycles to better suit the needs of childhood. He started his career in medical research, then as a Clinical Pharmacist and an Informatician. He developed experience leading innovative teams at Wolters Kluwer Health as the Vice President of Informatics and Clinical Development. There he spearheaded the creation of a solution that established the company as the recognized leader in the market within four years. He also led the informatics team at Hennepin County Medical Center before co-founding LogicStream Health.