The Opioid Crisis Continues: Have You Bolstered Your Health System’s Drug Diversion Defenses Yet?

By Tom Knight

After years of decline, 2020 and 2021 saw record rises in U.S. drug overdose deaths. In the 12-month period that ended in April 2021, more than 100,000 Americans died of drug overdoses, an increase of nearly 30% from the prior year, according to provisional figures reported by the National Center for Health Statistics. Opioids such as illegal synthetic fentanyl were linked with most of them.

In conversations with reporters last July, Dr. Nora Volkow, director of the National Institute on Drug Abuse, noted, “This is the highest number of overdose deaths ever recorded in a 12-month period.”

The pandemic derailed much of the progress we’d made in recent years. But that’s not where the story ends. The resurgence of the opioid crisis is overshadowing another looming crisis within healthcare settings: drug diversion, or the theft of medications and supplies intended for patients. A 2020 survey of healthcare professionals, sponsored by Porter Research and Invistics, showed that 73% of respondents strongly agree that most drug diversion goes undetected.

Unfortunately, this trend doesn’t bode well for 2022.

Healthcare organizations, whose staff are continuing to feel the stress of COVID-19, will need to double down on diversion prevention strategies in the coming months to avoid serious legal, financial, and clinical consequences, from massive monetary fines to the spread of healthcare-acquired infections such as hepatitis C.

Weakened defenses

Medication thefts are widely reported incidents, not anomalies. They occur in every healthcare setting, from hospitals to long-term care facilities to home care, and they increasingly target vulnerable patients who depend on opioids to avoid the pain of conditions like rheumatoid arthritis.

These thefts don’t just involve narcotics, as evidenced by an incident last summer where a New Jersey pharmacy technician was indicted for stealing more than $10 million worth of HIV prescription medications.

An impaired healthcare worker could harm a patient or even overdose themselves. For example, two nurses recently died of fentanyl overdoses at the same Dallas hospital.

Most clinicians and healthcare workers have had friends or colleagues impacted by these kinds of incidents—82% know someone who has diverted medications, according to the Invistics/Porter Research survey.

But even with record Drug Enforcement Administration fines for noncompliance with diversion prevention practices, many healthcare organizations have had to scale back their efforts. As many as 38% said their organization’s resources for drug diversion investigations were reallocated due to 2020 budget cuts, according to the survey.

With pandemic life creating shortages and fluctuations of clinical staff in healthcare settings, there are even more opportunities for theft. Clinicians who are preoccupied with a patient may not notice their colleague stealing medications, for example.

Avoiding crisis through stronger defenses

Given the escalating challenges of the broader world, healthcare organizations will need to take additional steps to lower the risk of drug diversion within their facilities, with emphasis on the following areas:

• Training. While a special report published by the American Nursing Association acknowledges that many healthcare workers “have difficulty believing their colleagues may be involved in drug diversion,” education is the most important step in raising awareness. Anyone who works with patients should be well versed in the signs of substance use disorders among their coworkers (e.g., frequent absences, slurred speech), as well as the consequences of diversion, including and beyond loss of employment.

• Dedicated staffing. Healthcare organizations investigated fewer incidents of drug diversion in 2020 and 2021 than in 2019, and only 45% reported having one or more full-time employees devoted to drug diversion, down from 58% in 2019. While the availability of advanced technologies can help detect potential patterns of diversion, this doesn’t eliminate the need for professionals who can focus on investigation and follow-up.
• Reporting. Sometimes clinicians see the signs of drug diversion but feel they shouldn’t report it, for example out of fear that a colleague could lose their job. Healthcare leaders need to take the stigma out of reporting substance use disorders, emphasizing the importance of employee health, workplace safety, and patient safety. They can also direct workers to use anonymous reporting tools such as HealthcareDiversion.org.
• Upgraded communications technology. The use of advanced technologies to detect diversion is catching on; 73% of respondents to the Porter Research survey support machine learning software and 88% support advanced analytics. But not all solutions are the same. To isolate patterns or behaviors associated with diversion in the shortest possible time frame, healthcare organizations need solutions that can utilize broad data sets from multiple sources—patient pain scales, clinical practice notes, staff reports, automated dispensing cabinet reports, etc. The right solution can detect a pattern of diversion quickly, within days or weeks, so authorities can prevent it from escalating—and this makes a huge difference. In some of the most high-profile healthcare diversion incidents, clinicians were only caught diverting medications after several years, which led to serious consequences, including prison time for the healthcare worker and adverse health outcomes for patients.
• Empathy. Last but not least, healthcare organizations need to encourage a culture of compassion, where clinicians who are at risk of opioid abuse and substance use disorders can get the help and support they need, whether that’s in the form of a treatment program or individual counseling.

Healthcare organizations need to do their part to address the prevalence of opioid use disorders and reduce the risk of diversion. By strengthening internal training, education, and other resources, as well as technology and support tools, health leaders will significantly lower their risk of diversion while staying true to their mission of keeping patients and communities safe.

Tom Knight is CEO of Invistics.