The theft of drugs and controlled substances by health care professionals is a serious problem that can lead to patient harm and jeopardize patient safety. Drug diversion involves the diversion of drugs from legal and medical necessary uses towards uses that are illegal and typically not medically authorized or necessary. According to the 2010 National Drug Threat Assessment report, the most commonly diverted controlled prescription drugs are opioids with related opioid deaths increasing 98 percent from 2001 to 2006. Opioid pain relievers include, for example, codeine, fentanyl, morphine and hydrocodone. The most common drug diverted from the healthcare facility setting are opioids.
Most drug prescriptions are for use in the outpatient setting and so most diversions of drugs occur there. Although a small portion of these drugs are administered in a health care facility, such as a hospital or outpatient surgery setting, the nature of the practices and ready access in some settings, provide ample opportunity for drug diversion. Although there are no precise national data on the extent of drug diversion from a healthcare facility, the most common drugs diverted are opioids. The adverse consequences of diversion include harm not only harm to the drug diverter, but also risk of harm for the patient. For example, numerous instances of hepatitis C transmission from an infected healthcare worker to a patient have been reported in the setting of narcotic diversion, as well as transmission of bacterial pathogens, with fentanyl being the most commonly implicated opioid.
A number of states have been actively addressing drug diversion and effective prevention methods for hospitals and healthcare providers. Some of the most comprehensive resources are available from the Minnesota Department of Health (MDH) as an outcome of the work of a coalition of the MDH and Minnesota Hospital Association along with hospitals, providers, law enforcement, licensing and other stakeholders. The coalition completed their work in 2012 and issued a final report and numerous resources for developing programs to effectively prevent and respond to drug diversions.
Patient harm – Visit our website on opioids and patient safety for additional information and resources on protecting patients from adverse events and harm related to prescribing, administration, and monitoring.
Premier Advisor Live® webinar:
Preventing theft of drug and controlled substances – a patient safety imperative September 26, 2012 2-3:30 p.m. ET.
Minnesota Department of Health campaign to respond to drug diversions
- Roadmap, tool kit, training materials, sample policies and procedures
- Flow chart of reporting guidelines to use when suspect drug diversion occurs
Mayo Clinic protocol – 77 best practices for storage, security, procurement, ordering, prescribing, preparation, dispensing, administration, inventory, recordkeeping, surveillance, investigation, education and quality improvement.
Hellinger WC et. Al., Healthcare-associated hepatitis C virus infections attributed to narcotic diversion. Ann Intern Med. 2012;156:477-482.
Berge KH et.al., Diversion of drugs within healthcare facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention. Mayo Clin Proc 2012; 87 (7):674-682
Schaeffer MK and Perz JF Outbreaks of infections associated with drug diversion by US healthcare personnel. Mayo Clin Proc 2014; 1-10