In 2014, almost two million Americans abused prescription opioids, resulting in more than 14,000 deaths and catching the attention of lawmakers and public health leaders across the country. While the federal government plays a role in addressing drug education, law enforcement, and the expansion of drug treatment programs, hospitals should also take active steps to protect their patients and communities from the harmful impact of drug diversion.
Drug diversion in the health care workplace
Approximately 20% of the population ages 12 and older reports using prescription drugs for nonmedical use at least once in their lifetime. Typically, these individuals misuse diverted prescription drugs—drugs that have been removed from the legal prescription drug supply chain. Commonly diverted drugs include opioids, stimulants, antiretroviral drugs, athletic performance-enhancing drugs, and non-opioid psychotropic drugs.
Without a sufficient system of checks and balances, many health care employees have unrestricted access to controlled substances throughout the medication order filling and dispensing processes. Hospital pharmacy leaders report increasing instances of diversion, including thefts of unopened vials, residual drugs left in a vial or syringe, and even substitution or dilution of medications intended for patients.
These incidents threaten patient and employee well-being, while also tarnishing the safety record of the hospital. Drug diversion risks patient harm if medications intended for patients are diluted or tampered. A health care provider diverting prescription drugs could even transmit pathogens, such as HIV or hepatitis C, through used syringes. In one upsetting example, a cardiac technologist, who worked in 18 hospitals in seven states, diverted narcotics for self-use and infected an estimated 46 patients with hepatitis C.
4 opportunities to minimize diversion risk
90% of reported theft or loss of controlled substances comes from pharmacies. With more than 12,000 reported thefts in three years, pharmacies have a role to play in securing controlled substances. Here are four opportunities, suggested by leaders in the field, for hospital-owned pharmacies to mitigate the risk of diversion:
- Ensure background checks and check references for all pharmacy employees: Background checks and reference letters can shed light on workers who have a history of reported drug diversion at previous jobs. Screening employees for a past drug security breach promotes a lawful and responsible work environment.
- Take advantage of security technology: Restrict access to pharmacies and dispensing units through biometric screening. These technologies provide added security compared to passwords, locks, or keys that are easy to override or duplicate. Install security cameras at any location where staff transfer prescription drugs, including loading docks, storage rooms, and dispensing areas.
- Maintain strict inventory management protocols: Though the DEA requires inventory of controlled substances once every two years, weekly or biweekly inventory checks for randomly selected controlled substances allow pharmacies to quickly identify if high-value prescription medications are missing. Hospitals should pay attention to any drug that cannot be accounted for and any medication that is being purchased or used more frequently over time, which is indicative of drug theft or loss.
- Designate a Drug Diversion Officer: Hospitals should nominate a security official as the Drug Diversion Officer. This individual monitors community drug use and potential security issues within the hospital’s pharmacy. The officer should also be responsible for testing security equipment and reporting drug diversion incidents.
Find out more about medication management at your hospital or health system through the Pharmacy Executive Forum.