The news has been full of stories on the opioid crisis and its impact on American society. The Drug Enforcement Administration and the federal government are putting resources into the war on drugs on the domestic front with new vigor. Prescribing rules and audits are now common to try to decrease the supply chain on availability of potential drugs of abuse. While these efforts are very positive steps forward, they’re only fighting the battle on one front. Winning the war will take multiple strategies, including in hospitals themselves.
Drug diversion is a phenomenon that refers to transfer of controlled substances from lawful to unlawful channels. In plain language, it means that someone takes drugs that are meant for patients and redirects them to use by someone who is not the patient. This most often occurs with people who work in the health care industry. By all means, it’s not the majority of drug misuse in this country. In fact, a study in 2016 showed that 6.2 million Americans over the age of 12 had misused drugs in the preceding month. These are staggering numbers. In contrast, the use by physicians is about 1 in every 950 or about 0.1 percent of the practicing physicians in the U.S. However, the impact of diversion is still very significant.
[See: 4 Opioid Drugs Parents Should Have on Their Radar.]
In general, diversion is an outcome of easier access. Doctors, nurses and pharmacists are often linked to diversion. But the truth is, anyone who has access to a hospital, either as part of the staff or even as a patient or visitor, may have increased opportunity to access drugs, including those of abuse. Certainly, the most common reason to divert those drugs intended for patients is to feed addiction. Sometimes, the theft is to support the habit of an associate of the perpetrator of the diversion, but usually it’s for the offender themselves. And the least common reason to divert is for the purpose of street sales, although with increases in heroin use and potential overdose, the street value of Narcan to reverse the effects is soaring ever higher, which might impact diversion for the purpose of selling. Other drugs also have higher street value, like performance enhancing drugs. This means the scope of diversion could be ever growing beyond the traditional drugs of abuse like opioids.
The negative impact of drug diversion can reach many. First of all, the risks to patients from care by an impaired provider, while extremely rare, are significant and fairly self-explanatory. For the addicted, there are very real risks including risk of accidental overdose, death and infections from using non-sterile needles. In addition, organizations and the entire health care industry are also at risk. Certainly there is liability regarding patient care, but also potential civil liability for failure to recognize and address diversion in the rare instances when it does occur. Investigations into such allegations are time-consuming and costly. In addition, impaired employees have increased absenteeism and lost time, burdening an already expensive health care system even more.
[See: On a Scale From 1 to 10: The Most Painful Medical Conditions.]
As the DEA continues to wage the war on drugs, certain measures have been instituted in the hospital setting. Visits from the DEA to facilities are becoming more common to examine any discrepancies that may occur. With mandatory reporting requirements, incidents may become public. To be ready for any inquiries, hospitals have developed entire programs around detection and monitoring for evidence of suspicious activity that may indicate diversion. Educating staff to look for signs of underperformance, behavior changes and drugs being in unusual and unexpected places may increase detection. Every hospital must have policies and procedures regarding diversion and procedures to monitor usage, particularly of narcotics. This may be as simple as labeling all medications and wasting excess in front of a witness. And while technology is not a solution on its own, automatic distribution machines can be audited to know who is accessing more often than would be expected, as well as reconciling waste. New narcotic disposal systems are being implemented across institutions that will render waste unusable and non-retrievable.
Physicians have been discussed in the war on drugs particularly with regard to opioid prescribing and the need to ensure that we’re not overtreating pain in patients. At the same time, physicians are being judged on their patient satisfaction, and these two things may not go hand in hand. That’s just one example of competing priorities that doctors face every day in the modern health care world. If you add up the stressors and then throw in easier access to medications, is it any wonder that an at-risk scenario for diversion has been created?
[See: 5 Common Preventable Medical Errors.]
In this new age of health care, we’re finally beginning to have open dialogue about physician wellness and attrition, which is sorely needed and quite overdue. We need to remember that the risks of destructive activities secondary to burnout and depression have far-reaching impact that we’re only beginning to uncover and address. Diversion is one of those areas that we’re beginning to confront. Let us make a promise to our health care community to do it in a constructive way, focusing on healing rather than punishment. We must remember that sometimes the physician becomes the patient and cannot heal themselves. We need to make sure our oath extends to all, including our colleagues, ensuring that we make plans to rehabilitate and welcome back into our practice fold when there is success without exception to the positive or negative. After all, that is what our patients deserve even when they wear a stethoscope.
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What to Do About Drug Diversion in Hospitals originally appeared on usnews.com
