Solutions for Drug Diversion’s Role in the Opioid Crisis
April 04, 2018
Most reports on the opioid crisis in America focus on individuals who receive a prescription for an opioid pain killer and then become a victim of opioid dependence. But what about the issue of dependence that occurs within the walls of the hospital? While 8% of the general population suffers with drug dependency, almost twice that number (15%) of healthcare workers are dependent on drugs and alcohol. This may be due to job stress and easy access to controlled substances. It is not unusual for drug dependent healthcare providers to risk patient safety by engaging in unethical and illegal medication tampering and misuse.
Drug Diversion Reveals Opiod Addiction a Problem for Healthcare Staff
“Many healthcare workers develop and feed their addictions through drug diversion—the transfer of any legally prescribed, controlled substance from the individual for whom it was prescribed to another person for any illicit use—which threatens patient safety. Often, when healthcare providers are diverting drugs, such as pain medications, they are stealing a prescribed medication for a patient and replacing it with some type of placebo, leaving the patient in pain” (Montgomery, 2017).
Furthermore, there are cases involving diverters using syringes on themselves first and then on patients, with the possibility of spreading diseases. One diverter is currently serving a 39-year prison sentence for infecting 45 patients through this deadly practice. The implications are not only related to patient safety—financial implications are also possible. A prominent academic medical facility was recently fined over 2 million dollars for poor practices that allowed drug diversion to occur (Montgomery, 2017).
- Drug Diversion: IT Solutions
Montgomery indicates that health IT can help. For example, automated dispensing cabinets (ADCs) can detect diversions in real time. Also, smart cabinets are able to detect pill miscounts or tampering with medicine cabinets and can connect this to an employee’s identification number. These actions along with monitoring each and every drug transaction via analytics are effective measures to counter drug diverters. Some facilities are going as far as hiring a drug diversion compliance officer to monitor drug flow across the hospital. (Montgomery, 2017)
Denial is a common response by many hospitals—some are unwilling to believe that drug diversion would occur in their organizations.
“Leading drug diversion experts believe that if a health system has controlled substances, a 100 percent chance exists for drug diversion. For successful control of the opioid crisis, widespread use and national adoption of health IT and other diversion prevention practices offer solutions (Montgomery, 2017).”
- Drug Diversion: Human Factors and Training as Solutions
Everyone that works with controlled drugs in a healthcare environment must be empowered to be vigilant, to question suspicious activities, and to act. This kind of vigilance and response may be difficult in an environment of intimidation. Thus, leadership must be supportive of staff that come forward and encouraged to bring up potential issues. “Typically we think of the staff that is most proximate to controlled drugs as having the greatest opportunity to notice when someone or something does not seem right. With drug diversion, all levels of staff should be encouraged to speak up including environmental service, food service, and maintenance. Empty drug vials in the wrong place or tampered waste containers may be evidence of diversion activities and should be brought to the attention of the department leadership. It is important for senior leadership to close the loop with staff who speak up to let them know the importance of their contributions to patient safety (Jorgenson, 2016).”
Teamwork is vital in ensuring safety in the lives of patients and staff and in identifying and dealing with drug diversion. An effective, comprehensive diversion program relies upon the functioning of a multidisciplinary team for guidance and oversight. “Since diversion is an organizational problem, the committee should have members from pharmacy, nursing, anaesthesia, security, accreditation, human resources, risk management, lab, environmental services, and human resources, as well as representatives from the medical staff and senior leadership. The team would be responsible for policies, procedures, staff education and training, diversion monitoring, and management of diversion events. Ideally the team would be aligned with other patient safety efforts and report through similar channels to the Board (Jorgenson, 2016).”
- Drug Diversion: Pharmacy Solutions
A third solution to the issue of drug diversion relates to the pharmacy. “It is extremely important that pharmacies be prepared to meet this challenge by focusing closer attention on prescriptions dispensed, ensuring that hiring policies and accountability policies and procedures are sufficient to detect, discover, and respond to the recent opioid drug crisis, as well as identify impaired health care workers and assist them in seeking appropriate programs for recovery (Montgomery, 2017).”
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Jorgenson, J. (2016). Drug diversion in hospitals: Are you next? Beckers Hopital Review. Retrieved from https://www.beckershospitalreview.com/hospital-management-administration/drug-diversion-in-hospitals-are-you-next.html
Montgomery, H. (2017). The opioid crisis in hospitals-what you may not know. HIMSS. Retrieved from http://www.himss.org/news/opioid-crisis-hospitals-what-you-may-not-know