The diversion of prescription medications by healthcare workers is a serious problem, and one that is both underreported and likely underestimated. By definition, drug diversion is the illegal distribution and use of prescription medications for unintended purposes such as recreation, monetary gains, or relief of withdrawal or addiction.
Although the term “diversion” doesn’t sound scary, drug diversion is an elusive activity with tragic downstream effects.There are significant financial, legal, and health implications that can affect many people beyond the person diverting the medication. Drug diversion by healthcare workers can impact the health institution they are employed by, their colleagues, their loved ones, and worst of all, the patients entrusted in their care.
Fighting back against drug diversion begins with acknowledging the potential for diversion in your workplace, appreciating processes that help mitigate the potential for diversion, and the knowledge to pick up on potential diversion activity. Here are some guidelines to help develop awareness about drug diversion and how to handle it in the workplace.
Prevalence of Drug Diversion
Presently, it is estimated that as many as 10% of healthcare workers will divert some form of medication from their workplace in their career. The prescription medications most commonly diverted are controlled substances like opioids, including hydromorphone, morphine, and fentanyl. While these medications are commonly associated with substance abuse, the number and types of medications that are diverted is quite broad.
Chemotherapeutic agents and antivirals are expensive and are therefore common targets. Non-controlled substances can also be diverted for personal use, such as performance-enhancing drugs (PEDs). Also, medications used to manage the symptoms of nausea and vomiting may be diverted alongside controlled substances to reduce withdrawal while on the job.
The financial implications of drug diversion are incredible, with an estimated cost of $70 billion a year. These dollars are distributed back to healthcare institutions and the public through addiction complications and management and the financial burden of replacing the lost medications.
Common Drug Diversion Methods
If you’re a healthcare worker who doesn’t believe drugs are being diverted at your place of employment, there’s a good chance you’re wrong. Despite safeguards and protocols put in place to prevent it, people can be quite creative in their methods. Like many crimes, drug diversion is sustained through the ability to remain hidden in plain sight.
The packaging and storage of medications have certainly improved in an effort to prevent drug diversion, but no solution is perfect. Removing medication from a vial, for example and replacing it with another liquid while being careful to preserve the seal and packaging can leave very little trace if unsuspecting coworkers aren’t looking closely.
Stealing Discarded Medications
The proper disposal and storage of controlled medication is a strictly guided process that requires a witness to the amount of medication being wasted and procedure on where that medication should be put for discard. With a diversion agenda in mind, the proper process is not followed and medications can be taken.
Prescription Pad Theft
Stealing prescription documents and forging the completion of those prescriptions is another common way for medication to be diverted. This is an especially concerning method as the quantities of diverted medications can be high.
Spotting Drug Diversion in Healthcare Facilities
Identifying potential drug diversion can be very challenging. Even with advanced surveillance software for medication dispensing machines and with strict policies and procedures in place, identifying when someone is diverting takes time and due diligence. Any suspicion of drug diversion must be reported to the DEA, but having your facts straight is essential.
Additionally, changes in the healthcare industry in recent years have made fact finding more complex. Persistent staff turnover following a stressful 3 years in healthcare plus the explosion of temporary staff have made things like incidence and tracking far more challenging than they once were. Aberrations from standard medication administration procedures is a great place to start and can include anomalies such as:
- Medication order, dose, and amount wasted do not match
- Medication waste often documented as “dropped” or “patient refused”
- Medications being pulled on a patient that healthcare professional is not responsible for
- Medications being pulled from locations that do not match the location of the patient
- Medication being pulled at the very beginning, or very end of the shift
- Accessing medications when not scheduled to work
Aside from workflow, there are ways to spot the potential for drug diversion when interacting with a colleague. If their chosen method of drug diversion includes personal use, you may see indications related to their behavior:
- Malaise, drowsiness, or forgetfulness
- Deteriorating person relationships
- Frequent occurrences of missing work
- Extended breaks
- Frequently disappearing
- Coming to work when not scheduled
- Signs of substance use disorder (sweating, nausea, vomiting, anxiety, irritability, diarrhea)
Reporting Drug Diversion
When suspicious of someone diverting medications, step number one is to report your suspicions to your supervisor. Concerns can then be escalated appropriately and an investigation can begin. Depending on what type of medication is being diverted, the DEA and law enforcement will need to be connected.
Consideration can also be given to reporting the incident to healthcarediversion.org, a national database working to build transparency around drug diversion.
Know How to Respond to Drug Diversion
Understanding how to recognize drug diversion by healthcare workers starts with knowledge and awareness on the significance of the issues as well as the signs. This is the best way to keep colleagues and patients safe.
Some states require education on the recognition and required reporting of suspected drug diversion in healthcare workers. Courses like Safe Opiate Prescribing (3 hr) by Premiere’s expert content developers offer excellent information on the recognition and response to impairment in the workplace for all healthcare workers.
Safe Opiate Prescribing (3 hr) was created by Mary Ellen Biggerstaff, DNP, MPH, FNP
Assistant Professor, Frontier Nursing University.