Drug Diversion in Healthcare: Risks and Prevention

A nurse caring for a patient who requires oxycodone/acetaminophen tablets for pain removes two of these tablets from an automated medication dispensing cabinet. As the nurse walks to the patient’s room, the nurse puts the oxycodone/acetaminophen tablets in a pocket and takes out two acetaminophen tablets brought from home. The nurse administers the acetaminophen tablets to the patient instead of the oxycodone/acetaminophen that the patient requires. No records or trending reports from the automated dispensing system indicate that the nurse is accessing medications at a greater rate than other facility staff; however, the patient has been complaining of greater pain levels during this nurse’s shifts. (O’Neal)

This is one example of drug diversion in healthcare settings. There are many other ways that drug diversion can occur. In general, drug diversion involves diverting controlled substances or other substances from appropriate distribution to other uses (e.g., substance abuse, illegal sales of drugs) (Yarin). Because of the large amount of these substances available in healthcare settings and the number of healthcare staff (e.g., pharmacists, pharmacy technicians, physicians, nurses, purchasing department staff) involved in purchasing and handling the drugs, hospitals are one of the most common settings in which drug diversion takes place. While most incidences involve diversion of controlled substances, some noncontrolled drugs (e.g., chemotherapeutic agents, human growth hormone) are also diverted for sale because of their high financial value.

Drug diversion may result in regulatory action by federal or state authorities, such as a suspension or termination of a facility’s U.S. Drug Enforcement Administration (DEA) registration, liability, or negative publicity for a healthcare facility. In situations such as the one described above, drug diversion may negatively affect patient care by hampering the patient’s recovery. Healthcare facilities should take proactive measures to prevent drug diversion and should not wait until an incident occurs. According to David Yarin, director, healthcare risk mitigation and compliance practice, Navigant Consulting, Inc. (Boston, Massachusetts), healthcare facilities must investigate and take actions to resolve any discrepancies involving controlled substances as soon as they are noticed. “It’s very difficult to go back and trace through records covering a long period of time,” he says.

This article provides an overview of drug diversion in healthcare, identifies risk areas where diversion is most likely to take place, outlines strategies for preventing drug diversion, and provides tips for handling drug diversion when it does occur. In addition, the risks and benefits of using automated dispensing units are discussed. Some of the information included in this article is taken from the six-part series, Prevention of Controlled Substance Diversion—Scope, Strategy, and Tactics, that appeared in Hospital Pharmacy from February 2007 to July 2007 and the accompanying article, “Controlled Substance Diversion Detection: Go the Extra Mile,” from the September 2004 issue of the same journal. The series provides comprehensive information for handling controlled substances and preventing drug diversion in the acute care environment and highlights the experiences of the Ohio State University Medical Center (OSUMC) in Columbus and the University of Kansas Hospital in Kansas City. Jerry Siegel, Pharm.D. , FASHP, senior director of pharmaceutical services, OSUMC, and Brian O’Neal, M.S., Pharm.D. , assistant director of pharmacy, department of pharmacy, the University...