Explore the issue of drug diversion in healthcare systems, where prescription drugs are illegally distributed or abused for non-medical purposes. Learn about the risks, impacts, and cases of harm caused by drug diversion among healthcare professionals and patients. Discover how drug diversion can lead to addiction, overdose, and even death, affecting the integrity of the healthcare system.
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Drug diversion is the illegal distribution or abuse of prescription drugs for purposes not intended by the prescriber It can involve both patients and medical professionals using the drugs for: Recreational purposes Relief of addictions Monetary gain Self-medication for pain or sleep To alleviate withdrawal symptoms Providers risk losing their licenses, credentials and employment and in some cases may be punished by prison terms and fines
Drug diversion can lead to addiction, overdose, patient harm and death In 2020, the CDC reported almost 100,000 drug involved overdose deaths, with over 68,000 deaths from opioids1 It is estimated that about 10% of health care workers are abusing drugs2 1Overdose Death Rates. National Institute on Drug Abuse, Jan 20, 2022. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates 2Drug Diversion and Impaired Health Care Workers, https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_drug_diversion_final2pdf.pdf
When healthcare professionals divert drugs they can cause harm to patients by: Causing substandard care to be delivered by an impaired provider Denying essential pain medications or therapy to the patient Increasing the risk of infection (e.g. Hepatitis C or bacterial pathogens) if the provider tampers with injectable drugs
In 2012, at least 30 cases of Hepatitis C infection were caused by a radiologic technician in New Hampshire His actions could have potentially infected thousands of patients Technician was injecting himself with fentanyl and replacing the dirty syringes with saline solution for patient use He was sentenced to 39 years in prison
In 2010, a technician at the Mayo Clinic in Florida infected 5 patients with hepatitis C, one of the patients died He injected himself with fentanyl syringes that were to be used during surgical procedures and replaced the contents with saline contaminated with hepatitis C Thousands of patients had to be tested and were potentially at risk He was sentenced to 30 years in prison
Diversion Method Description Selling prescription drugs Selling drugs that were obtained legally Doctor shopping Soliciting multiple physicians to receive controlled substances Illegal internet pharmacies Rogue websites that provide controlled substances without prescriptions Drug Theft Stealing drugs at any stage of the drug supply chain Prescription pad theft and forgery Printing, stealing or altering Rx pads to write fraudulent prescriptions Illicit prescribing Prescribing larger quantities or unnecessary prescriptions ( pill mills )
The DEA categorizes certain drugs as controlled substances based on the drug s intended use and the potential for abuse/dependence The drugs listed below are considered to have high potential for diversion Drug Class Examples Anabolic steroids Methyltestosterone, testosterone CNS Depressants Barbiturates, benzodiazepines Hallucinogens Ketamine Opioids Fentanyl, hydrocodone, morphine, oxycodone Stimulants Amphetamine, methamphetamine
Prescribers should take precautions to avoid drug-seeking patients taking advantage of them They can include: Documenting thoroughly when prescribing or choosing not to prescribe narcotics Protecting access to prescription pads Keeping a DEA license number confidential unless disclosure is required by law Adhering to strict refill policies Using the Prescription Monitoring Program I-STOP to monitor patient prescribing before refilling or adding new medications
Providers can curb drug diversion by adhering to prescribing principles for opioids and other controlled substances such as: Completing a full evaluation and assessment to verify the need for pain medication Screening for substance abuse and asking about the medications the patient is taking and why Prescribing opioids only if alternative therapies do not deliver adequate pain relief Using pain assessment tools to monitor the effectiveness of the medications
The Affordable Care Act has implemented significant changes to federal health care programs These changes include: If providers are terminated for cause by Medicare or any Medicaid agency, they must be terminated by Medicaid and the Children s Health Insurance Program (CHIP) in all states Attempting to obtain a controlled substance by misrepresentation, forgery, fraud or deception is a felony in most states and punishable by a prison term and fines The Office of Inspector General also uses law enforcement tools that can impose various legal sanctions and actions on physicians and other providers, including civil monetary penalties, suspension or loss of license and exclusion from Federal health care programs
Suspected drug diversion is documented and reported to the DEA through a collaborative effort between the Security and Pharmacy departments They work directly with the DEA on any investigation being conducted Local law enforcement could also potentially be involved if other criminal charges will be filed If you suspect another provider or staff member of drug diversion contact the Director of Pharmacy, any member of Senior Leadership or Security
Overdose Death Rates. National Institute on Drug Abuse, January 20, 2022. Web. 01 September 2022. Drug Diversion and Impaired Health Care Workers . Joint Commission, April 2019. Web. 01 September 2022 Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits , The Dawn Report, December 28, 2010 Perz, Joseph. "Drug Diversion in Healthcare Settings." CDC Expert Commentary. Medscape, 2 June 2014. Web. 06 July 2016. "Risks of Healthcare-associated Infections from Drug Diversion." Injection Safety. Centers for Disease Control and Prevention, 08 Sept. 2015. Web. 5 July 2016. Sheon, Stacey. Radiologic Technician Convicted of Infecting Patients with Hepatitis C. Biotechnology Law Report 31.4 (2012): 382. University of Houston Law Center, Mar. 2013. Web. 01 July 2016. "Spotlight On... Drug Diversion." Spotlight Articles. Office of Inspector General, n.d. Web. 05 July 2016. "What Is a Prescriber s Role in Preventing the Diversion of Prescription Drugs?" Medicare Learning NetworkICN 909010 (2016): Feb. 2016. Web. 01 July 2016.
