Drug Diversion 101: What You Need to Know

This is the first of a series of articles about drug diversion.

Drug diversion by healthcare workers is a multi-faceted, serious issue that has a number of consequences. Not only is the person committing drug diversion affected, the healthcare institution, patients and community in general are impacted as well. In order to take steps to detect and prevent drug diversion in hospitals and other facilities, it’s important to know what diversion is and the factors that contribute to this ongoing healthcare concern.

What Is Drug Diversion?

In short, drug diversion refers to healthcare workers taking medications—typically narcotics—that are intended for patients and using them for their own personal use or gain. Healthcare workers often commit diversion during the process of dispensing controlled substances. Drug diversion poses significant risks to patient safety and has become a major healthcare concern across the country.

Though drug diversion can’t be prevented entirely, there are steps that can be taken in order to detect and respond to diversion incidents. We’ll cover the steps in detail in future articles. Because diversion occurs in all healthcare facilities, it’s vital that institutions prevent what they can by learning to detect diversion quickly. Transaction analytics programs are making diversion detection much faster and more efficient, giving healthcare institutions a leg up on drug diversion.

Drugs of Choice

Although every diversion scheme is different, there are a number of commonly diverted drugs. Often diverters will settle on one or two drugs of choice, with over 50 percent of diverters starting with injectable opioids. Medications like morphine and propofol are popular choices for diverters as they can be injected intramuscularly, reducing the risk of visible signs of diversion on their body. Other drugs of choice include pills and liquids such as hydrocodone and oxycodone as well as barbiturates, benzodiazepines and anesthesia gases.

Who Commits Diversion?

Drug diversion can occur anywhere controlled substances are found and can be committed by anyone with access to these drugs. Diverters tend to be secretive in their actions, making it difficult to identify when diversion is occurring. In general, healthcare professionals who deal with the dispensing of controlled substances may be more likely to misuse medications.

There are numerous ways diverters steal medications from healthcare facilities. Some of the methods include:

  • Giving a patient part or none of the prescribed dose while documenting that the full dose was administered
  • Falsifying patient records in order to steal the available drug supply
  • Injecting themselves with the drug and refilling the container with water, saline or other substances
  • Dispensing controlled substances in greater amounts than needed in order to pocket the leftover medication

Is Drug Diversion on the Rise?

The U.S. Department of Health and Human Services Office of Inspector General (OIG) investigations of drug diversion have increased in recent years. One reason for this may be that drug diversion can be very lucrative if the drugs are trafficked rather than diverted for personal use. The types of medications that diverters are stealing can often be illegally sold for hundreds or thousands of dollars. However, in most cases healthcare diverters are stealing for personal use.

Drug diversion schemes can involve multiple parties, all who might benefit from the crime in question. The OIG has investigated cases which involved a long chain of participants, from pharmacies to healthcare providers to patients themselves, highlighting how the impact of diversion can move beyond the walls of healthcare institutions.

Continuing the Diversion Discussion

In the next article on drug diversion we’ll focus on the various ways drug diversion causes harm to patients, and future posts will discuss taking the proper steps to identify, monitor, and prevent drug diversion.

Diversion Management Webinars: To learn more about diversion, view our series of Diversion Management webinars hosted by Omnicell and presented by Kimberly New, JD, BSN, RN.

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