Diversion on the Rise
By Amanda McKnelly and Maria Eining
The misuse and abuse of drugs is a crisis in our country and around the world. By 2020, mental health and substance use disorders are expected to surpass all physical diseases as a major cause of disability worldwide.
Drug diversion is any intentional removal of a prescription medication from the legitimate channels of distribution or dispensing. Prescription drugs are abused and misused more often than any other drugs except marijuana and alcohol (SAMHSA/NSDUH, 2014a). The 2013 National Survey on Drug Use and Health (NSDUH) indicates that 15.2 million people age 12 or older used prescription drugs non-medically in the past year, and 6.5 million did so in the past month.
With drug diversion on the rise, our health systems are starting to see the effects diversion has on their systems as a whole. Healthcare professionals face a dilemma because their patients often need prescription drugs but there is also a need to prevent the diversion and misuse of drugs. Pain relievers including opioid analgesics, tranquilizers, stimulants, and sedatives are the prescription drugs most often misused or diverted. Opioid analgesics are powerful painkillers with valid medical indications; however, when the patient takes the wrong dose, or the wrong person takes the opioid pain medication, consequences can be deadly.
What is the role of healthcare professionals in the problem of prescription drug diversion, misuse, and abuse? Healthcare professionals are in a unique position to educate, identify, and intervene with patients and colleagues who are at risk for prescription drug misuse and abuse. Recognizing the signs of misuse and risk factors of drug abuse and diversion by patients and fellow healthcare professionals is an important responsibility of all clinicians. Educated healthcare professionals can be instrumental in changing patterns of misuse and abuse of prescription drugs for individuals, colleagues, and communities, and thereby reducing the public health epidemic.
Substance use disorders have been identified as an occupational hazard for healthcare professionals. Healthcare professionals experience substance use disorders at the same rate as the general population; however, have a higher rate of abuse of opioids than the general population. A healthcare professional may have an illness, injury or emotional or physical pain condition that allowed for a valid prescription prior to drug diversion. Of course, not all who have used opioids will abuse them and not all who have abused will divert but for those that divert, the majority will divert illegally from the hospital or facility they were working at. Human Resource departments have mentioned that when they go back and look at an individual that has been suspected of diversion, the signs and are all there, but no one knew what they were all looking for.
Signs and symptoms for healthcare professionals who may be diverting due to a prescription drug substance use disorder can include the following:
● Coming to work on days off
● Volunteering for overtime
● Incorrect narcotic counts
● Volunteering to administer medications
● Waiting to be alone to open a narcotics cabinet
● Not having witnesses to verify the waste of unused medications
Negative impacts on patient safety may result from any of the following:
● Impaired judgment
● Slowed reaction time
● Diverting drugs from patients who need them
● Falsification of records (fraud)
Facilities have “checks and balances” of the daily routines of their providers and employees, even so it is estimated that with the most robust prevention program possible facilities may have a 5% diversion rate and a 15% diversion rate in the absence of monitoring. Healthcare professionals educated in diversion prevention have the potential to make a difference. If a healthcare professional suspects that drug diversion has occurred, he or she should document the suspicion and make a report to their supervisor- they may notice signs symptoms or changes in behavior before monitoring systems identify anomalies. Healthcare facilities, law enforcement, licensing boards and alternative to discipline programs can then work together to protect the public and to assist the healthcare professional to receive necessary treatment. Healthcare professionals whose substance abuse problems are detected early and treated have a higher likelihood of successful treatment outcomes (NCSBN, 2011) and can go on to be a valuable member of the healthcare community and workforce.
American Society of Addiction Medicine (ASAM). (2012). Public policy statement on measures to counteract prescription drug diversion, misuse, and addiction. http://www.asam.org.
Berge K, Dillion K, et al. Diversion of Drugs Within Health Care Facilities, A Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention. Mayo Clin Proc 2012; 67(7) 674-682
Clark C. Dealing with Drug Diversion. Health Leaders Jan/Feb 2015 57-60.
National Center for Health Statistics (NCHS). (2014). Health, United States, 2013: In Brief. Hyattsville, MD. http://www.cdc.gov/nchs/data/hus/hus13_InBrief.pdf.
National Council of State Boards of Nursing (NCSBN). (2011). Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs. https://www.ncsbn.org/SUDN_11.pdf.
National Institute on Drug Abuse (NIDA). (2014). Prescription drugs: Abuse and addiction (NIH Pub Number 11-4881). http://www.drugabuse.gov/publications/research-reports/prescription-drugs.
National Survey on Drug Use and Health (NSDUH). (2013). Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings and Detailed Tables. http://media.samhsa.gov/data/NSDUH.aspx.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014b). Specific Populations and Prescription Drug Misuse and Abuse. http://www.samhsa.gov/prescription-drug-misuse-abuse/specific-populations.
Amanda McKnelly and Maria Eining and the owners of Midwest Health Management Services in Sioux Falls.