Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review

Fitzsimons, Michael G.; Sousa, Gabriel Soares de; Galstyan, Arpine; Quintão, Vinícius Caldeira; Simões, Cláudia Marquez

doi:10.1016/j.bjane.2023.07.008

Cited by 3 publications

(1 citation statement)

References 54 publications

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“…Drug diversion is not only a criminal offense but also profoundly detrimental to both patients and healthcare providers [11]. Patients might be deprived of essential treatments, hindering their recovery and overall well-being [49]. Financially, the cost would incur for diverted medication not used for intended patient care leads to unwarranted expenses.…”

Section: Discussionmentioning

confidence: 99%

Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study

Kim,

Han,

Trinkoff

et al. 2024

BMC Nurs

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Background Prescription drug misuse has been identified as a global issue of concern. Nurses’ prescription drug misuse is linked to personal health problems and impaired nursing care. This study explored the level of South Korean hospital nurses’ prescription drug misuse and examined associations with workplace access and burnout. Methods This cross-sectional study used data from 1142 nurses working in South Korean hospital settings. Nurses completed the online survey anonymously. Descriptive analysis, logistic regression, and Shapley value assessment were conducted. Results Pain relievers (44.2%), IV drips (26.8%), and antibiotics (13.5%) were the most commonly misused drugs among hospital nurses. Accessibility in the workplace was high, with nurses reporting frequent administration of IV drips, pain relievers, and antibiotics and perceiving these drugs as easily accessible. Logistic regression demonstrated that perceived availability was significantly related to misuse across all drug types. Burnout was associated with IV drips, sleeping pills, and steroids, increasing the likelihood of misuse. Shapley feature importance analysis highlighted perceived availability as the most influential factor for IV drips, pain relievers, and steroids, while burnout emerged as crucial for antibiotics and sleeping pills. Notably, age played a significant role in appetite suppressant misuse, distinguishing it from other drugs. Conclusion Our results revealed that workplace access and burnout are associated with nurses’ prescription drug misuse. Effective educational strategies are essential for enhancing nurses’ willingness to seek help for personal health issues. Hospital organizations play a crucial role in facilitating access to healthcare and fostering a supportive environment for nurses to seek treatment when necessary. Additionally, governmental policies should prioritize the implementation of active surveillance systems to monitor medication usage in healthcare settings, thereby mitigating drug misuse among healthcare professionals. By addressing these issues, we can ensure the well-being of nurses and promote a safer healthcare environment.

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Section: Discussionmentioning

confidence: 99%

Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study

Kim,

Han,

Trinkoff

et al. 2024

BMC Nurs

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When Oxybutynin Becomes a Decoy for Oxycodone: A Case Report of Diversion Through Substitution

Verdiner,

Voils,

Seim

et al. 2024

Drug Testing and Analysis

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This case report describes the novel use of oxybutynin and acetaminophen as a substitution for oxycodone for the express purpose of diverting oxycodone in a hospital‐based post‐anesthesia care unit (PACU). The report outlines how the physical properties and pharmacologic effects of non‐controlled medications in the PACU, like oxybutynin, can be visually mistaken and even mimic the side effects of controlled substances like oxycodone. Substituting oxybutynin for controlled substances can circumvent diversion surveillance software. The authors describe how the diversion was identified and the process improvements that should be implemented for proactive identification moving forward.

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Comparison of Intraoperative Fentanyl Usage and Waste After Transition from 100-μg Vials to 50-μg Preloaded Syringes: A Single-Center Retrospective Study

Huang,

Lai,

Bhavsar

et al. 2024

IJACM

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Background: The rapidly acting opioid fentanyl, commonly used in the perioperative setting, has traditionally been packaged in 100 or 250-μg vials. In September 2021, our institution implemented a change from fentanyl 100-μg vials to 50-μg preloaded syringes in our operating rooms. The objective of this study was aimed at assessing the association of the fentanyl product change on reducing medication waste and the amount of fentanyl administered during surgery. Methods: This single-center, retrospective study entailed a review of anesthesia records from September 2020 to September 2022 of adult patients who underwent general anesthesia and received fentanyl for surgery at The University of Texas MD Anderson Cancer Center. The data set was divided into a control period (CP) using 100-μg vials and a post transition period (PT) using 50-μg preloaded syringes. The primary outcome measures were the average amounts of fentanyl used and wasted per case. Secondary outcome measures consisted of intraoperative analgesic use as well as postoperative pain scores. Results: Among the 33,405 cases included in this study, the mean amount of fentanyl used per surgical case was higher in the CP group than in the PT group (133μg vs. 102μg; p<0.001). Additionally, fentanyl waste occurred in a higher percentage of cases in the CP group than in the PT group (13.9% vs. 2.9%; p<0.001). We did not observe a significant difference in post-anesthesia care unit pain scores between the CP and PT groups. Conclusion: Transitioning to preloaded fentanyl syringes decreased medication waste and overuse of opioids intraoperatively. Simultaneously, the transition did not adversely affect patient analgesia in the post-anesthesia care unit.

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Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review

Cited by 3 publications

References 54 publications

Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study

Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study

When Oxybutynin Becomes a Decoy for Oxycodone: A Case Report of Diversion Through Substitution

Comparison of Intraoperative Fentanyl Usage and Waste After Transition from 100-μg Vials to 50-μg Preloaded Syringes: A Single-Center Retrospective Study

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