Drug diversion, the term for healthcare workers stealing medicine intended for patients, is a painful reality in today’s healthcare environment and often hard to identify without sophisticated analytical tools.
Drug diverters devise clever ways to get their hands on a surprising variety of substances for a range of abuse not limited to personal consumption. And they often cover their tracks.
Fortunately, drug diverters are a distinct minority (Studies in the United States have shown that about 15% of healthcare workers are reportedly abusing drugs). Nonetheless, their numbers are certainly large enough to harm healthcare systems, their finances, their reputations, and their patients.
Healthcare systems have gone to great lengths to address the multifaceted problem, creating hardworking oversight committees executing laborious processes with varying success. These committees have often attempted to manually audit every prescription from the pharmacy to the patient (and back to the pharmacy if there’s excess medicine to be disposed of) across the hospital.
This effort has revealed a lot of insights over the years. Most recently, insights have been revealed through technology, including sophisticated software solutions, artificial intelligence, and even machine learning. These packages detect anomalous drug-flow patterns that suggest diversion activity and would otherwise remain hidden.
Identifying signs of drug diversion can be challenging, but is a crucial step in reporting and halting drug diversion in healthcare. Therefore, I sat down with former Directors of Pharmacy and Clinical Consultants, Carla Maslakowski and John Donnici, to discuss firsthand common myths associated with identifying drug diversion in healthcare facilities.
MYTH #1: Passing a drug test proves innocence.
False. Diverters don’t always abuse the drug themselves. They may be selling medicines or giving it to family members. We helped identify one nurse who systematically supplied stolen medications to her husband, a long-haul trucker, who would sell the illicit substances far and wide. In another instance, an employee diverted narcotics to a spouse who was suffering chronic pain and depression. Although the employee’s heart was in the right place, she approached the problem in a dangerous way.
MYTH #2: If there is a match of a dispensed medication from an automated dispensing cabinet and a documented administration of that medication to the patient, then there is no need for concern for drug diversion.
This is not only a myth but a huge misconception and falsehood. Many drug diversion analytics solutions predicate the basis for a match (or non-match) of a dispense and documented administration as the impetus for drug diversion. Nothing could be further from the truth and has proven to be a complete misconception and loophole for drug diversion analytic solutions being toted in the industry. A sophisticated and diligent drug diversion candidate will be very judicious in hiding their tracks and document everything dispensed as being administered thus never raising that “red flag.”
MYTH #3: Long-time employees are beyond suspicion.
False. One of our diversion cases involved a veteran nurse with decades of tenure. This employee was particularly resistant to new technology and procedures being implemented across the facility. It was soon discovered she knew exactly how the technology worked and was quietly replacing morphine in patient-controlled analgesic devices with water or saline, putting critical patients at risk.
MYTH #4: Doctors don’t divert.
Not true, unfortunately. Discrepancies in medicine flow led us to the office of a celebrated Anesthesiologist. When we removed his ceiling tiles, we found a cache of syringes and diverted medicines. The classic anesthesiology diversion scenario involves a doctor administering only half of a prescribed medication to the patient from behind a sterile curtain in an operating theater, before stockpiling the rest.
MYTH #5: Certain drugs can’t be abused.
Arguably true, but the scope of abusable drugs is often wider than we think. In one hospital, we saw repeated discrepancies around anti-nausea drugs, which purportedly trigger euphoria in some individuals. Tylenol 3 has codeine and can be addictive. Benadryl (both a sedative and mood enhancer) can also be abused, and is commonly diverted.
MYTH #6: Trash is trash.
Not always. In one diversion example, a hospital started requiring used fentanyl patches to be discarded in special red medical waste buckets. That practice unintentionally made it easy for an abuser to collect remnant quantities of the potentially lethal painkiller in significant volumes.
MYTH #7: Patient-facing employees are the ones who need to be watched.
This is proven to be false. We helped detect a long-term, loyal hospital employee who had risen to the position of senior pharmacy technician in charge of pharmacy inventory, working among shelves of medications in the back of the department. The inventory area lacked cameras and effective custody controls, easily concealing the drug diverters tracks. The technician simply skimmed a quantity of inventory for sale outside the pharmacy.
MYTH #8: Employees who always go the extra mile are safe.
Many are, but drug diverters are keenly aware of the value in crafting an impeccable persona. A classic tactic is volunteering for extra shifts. In addition to being valued by superiors, it provides drug diverters more opportunities to divert drugs.
MYTH #9: ‘This health system doesn’t have a diversion problem.’
Unfortunately, virtually no system of any size completely lacks diversion activity. Even if a surveillance team has not detected suspicious activity, it may take powerful technology to uncover anomalous activities – technology that humans can’t match with paper records or spreadsheets. The good news is that the technology pays for itself in avoided fees, labor, reputational damages, and patient suffering.
MYTH #10: Cracking down on diversion puts you at odds with your colleagues.
Although surveillance teams are sometimes derided as “pharmacy police,” teams can win over colleagues by thoroughly explaining the diversion problem, the objective nature of detection technology, the institution’s legal obligations, and how diversion detracts from patient safety. Hospital systems should be involving staff early and make them part of the solution.
Although drug diverters constitute only 10-15% of the healthcare workforce, in a workforce of 22 million in the U.S. alone, that’s a lot of risk, including patient suffering, clinician misconduct, substance abuse, and reputational damage to the institution and industry.
Understand the myths and the truths, implement the necessary technology, and help deliver medicines to those for whom they were prescribed.