Fixing Clinical Burnout Could Reduce Drug Diversion in Healthcare Settings

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Burnout isn’t always correlated with drug diversion, but addressing one problem can mitigate the other

By Tom Knight

There isn’t a healthcare worker in the United States whose job hasn’t been impacted by COVID-19 and the lingering uncertainty it brings.

Burnout already affected more than half of all physicians prior to the coronavirus pandemic, and it has only intensified among doctors and other healthcare workers in recent months. According to a recent survey, 65% of physicians indicated that the COVID-19 pandemic has increased their feelings of burnout, as they feel overwhelmed and helpless in the face of the virus. And increasing burnout is widely reported in nursing, pharmacy, and nearly all other clinical areas.

Mental health and substance use disorders have also escalated. In December, the Centers for Disease Control and Prevention (CDC) reported that more than 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020—the highest number of overdose deaths ever recorded in a 12-month period.

This is highly concerning, but not just because of the correlation between clinician burnout and substance use disorders. The prevalence of clinical worker burnout also raises the risk of drug diversion in healthcare settings.

Already, an overwhelming majority (86%) of healthcare workers said in 2019 that they know someone who has diverted drugs, according to the 2020 Porter Research Survey on drug diversion in healthcare settings, sponsored by Invistics.

A CDC report observes that the incidence of drug diversion in healthcare settings has increased significantly since the late 1990s, when prescription opioids became more easily available to consumers. The number of healthcare-acquired infections connected to drug diversion also increased, according to the same report.

While burnout doesn’t cause drug diversion, burnout is correlated with substance use disorders, and substance use disorders are correlated with drug diversion.

How burnout drives drug diversion

One of the problems with burnout is that it manifests in a wide range of symptoms, such as depression, fatigue, or antipathy. These are not always easy to recognize. Healthcare professionals are busier than ever and may miss signs of burnout in their peers, or even in themselves. Sadly, the topic often bubbles up to the surface of our consciousness when we hear vivid examples of its human cost, such as the New York City emergency physician who committed suicide in April.

In the same way, some people are shocked to hear about a nurse or pharmacist who repeatedly diverts patients’ medication for weeks on end, sometimes infecting patients in the process. It’s not uncommon to learn that a clinician diverted medications “here and there” to take the edge off a 12-hour shift, only to grow more dependent over the days and weeks that followed.

One has to wonder: If there were an easier way to identify clinicians experiencing severe burnout, how many cases of drug diversion could be stopped?

Finding solutions

Leading healthcare organizations are looking to help their clinicians, both with burnout and with diversion prevention.

For starters, healthcare leaders can approach the problem of burnout with compassion and thoughtfulness by addressing root causes: time pressures, increasing workloads, and time-wasting activities that rob clinicians and their patients of time for needed care.

“Sadly, hospitals and other medical institutions have tended to address the problem of physician burnout merely by giving their doctors inspirational talks about ‘resilience,’ patting them on the shoulder, and then sending them back into their deteriorating clinical lives with no material change in circumstances,” wrote Peter Grinspoon, MD, author of the memoir Free Refills: A Doctor Confronts His Addiction, in a 2018 post for the Harvard Health Blog. The same can be said all too often for nurses, pharmacists, and other clinicians. What’s better, says Grinspoon, is making changes that ease real, day-to-day challenges, such as implementing an electronic health record (EHR) that prioritizes facilitating physician-patient conversation rather than maximizing revenues.

There’s also an opportunity to enhance education and training on substance use disorders, both in patients and clinical workers. Most clinical leaders educate their staff on recognizing the signs of substance use disorder and how to report suspected incidents. But healthcare leaders should take this one step further—for example, by sharing news reports of healthcare workers whose drug diversion affected patients.

Meanwhile, healthcare organizations should audit both technology and processes used to detect and investigate drug diversion. Healthcare leaders should ask themselves:

  • What is our organization doing to track medication from the moment we purchase it and it arrives on our loading dock?
  • What technology are we using throughout the supply chain to detect issues?
  • Are we syncing all of our sources of information—EHRs, patient pain ratings, pharmaceutical dispensing records—and receiving alerts when patterns or behaviors associated with diversion occur?
  • Are we documenting reports of clinical burnout so we can see if they correlate with drug diversion?

The more work the healthcare industry can do ahead of time, the less work there will be down the road. While medicine will never be an easy profession, we can protect our providers and patients by taking seriously the correlated issues of burnout, substance use disorder, and drug diversion.

Tom Knight is co-founder and CEO of Invistics Corporation.