Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention

Abstract

Mayo Clinic has been involved in an ongoing effort to prevent the diversion of controlled substances from the workplace and to rapidly identify and respond when such diversion is detected. These efforts have found that diversion of controlled substances is not uncommon and can result in substantial risk not only to the individual who is diverting the drugs but also to patients, co-workers, and employers. We believe that all health care facilities should have systems in place to deter controlled substance diversion and to promptly identify diversion and intervene when it is occurring. Such systems are multifaceted and require close cooperation between multiple stakeholders including, but not limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel, and human resources. Ideally, there should be a broad-based appreciation of the dangers that diversion creates not only for patients but also for all employees of health care facilities, because diversion can occur at any point along a long supply chain. All health care workers must be vigilant for signs of possible diversion and must be aware of how to engage a preexisting group with expertise in investigating possible diversions. In addition, clear policies and procedures should be in place for dealing with such investigations and for managing the many possible outcomes of a confirmed diversion. This article provides an overview of the multiple types of risk that result from drug diversion from health care facilities. Further, we describe a system developed at Mayo Clinic for evaluating episodes of potential drug diversion and for taking action once diversion is confirmed.

Risks Associated with International Trading of Medicines by Non-Licensed Entities and Non-Professionals

“…It should be noted that non-professional healthcare workers or support staf members have been and are also a source of stolen products from health facilities. These products end up in the streets to be sold by unlicensed entities and non-professionals including legitimate or illegitimate traditional healers, herbalists, drug dispensers and other small traders [85][86][87][88][89].…”

Non-opioid anesthetic drug abuse among anesthesia care providers: a narrative review

“…62 Preventive strategies can be instituted to facilitate active detection of diversion, for example, proper regulation of controlled drugs and substances with the potential for abuse. 33,[63][64][65][66][67][68] Other important preventive measures include random drug screening [69][70][71][72][73] and performance assessment conducted by properly trained personnel to detect the problem in its early stages. 9,60,74 Once substance abuse has been identified, ACPs can be referred to programs that specialize in physicians with substance use disorders.…”

A Need to Establish Programs to Detect and Prevent Drug Diversion

“…As described by Berge et al, 3 drug diversion is not a "victimless crime." It poses risks to health care workers, their colleagues, and their patients.…”

“…Some of those likely know at least 1 physician who died as a result of an overdose, and others are aware of patients who have been mistreated because their physician either had taken the opioids meant for patient care or were intoxicated while providing patient care. The article by Berge et al 3 only begins to open the Pandora's box of drug diversion by medical personnel. Because system-wide practices are not in place to detect drug diversion, its frequency is likely underreported.…”

“…There are many facets to the institution-wide program outlined by Berge et al 3 The success of such a program requires education, cooperation across several hospital divisions and offices, personnel, time, and money. When diversion is suspected or identified, an investigation that includes drug testing is initiated.…”