Infection Prevention’s Role in Curbing Drug Diversion

Can you give us some background on drug diversion? How prevalent is drug diversion among healthcare workers?

Drug diversion is defined by HHS as “the illegal distribution or abuse of prescription drugs or their use for purposes not intended by the prescriber. Prescription drug diversion may occur at any time as prescription drugs are distributed from the manufacturer to wholesale distributors, to pharmacies, or to the patient. Members of the medical profession may also be involved in diverting prescription drugs for recreational purposes, relief of addictions, monetary gain, self-medication for pain or sleep, or to alleviate withdrawal symptoms.”

HHS also says that the most common types of drug diversion are selling prescription drugs, doctor shopping, illegal internet pharmacies, drug theft, prescription pad theft and forgery, and illicit prescribing. Further, HHS says that the drug classes with the highest potential for drug diversion and abuse (according to the National Institute on Drug Abuse (NIDA) and the U.S. Drug Enforcement Administration (DEA)) are anabolic steroids, central nervous system depressants, hallucinogens, opioids and stimulants.

As for prevalence among healthcare workers, according to an article entitled “Impaired healthcare professional” by Marie R. Baldisseri, one in 10 healthcare workers misuse drugs or alcohol during their careers.

*Editor’s Note: Please see the accompanying sidebar for relevant studies on the prevalence of drug diversion provided to HPN from Davis.

What tactics or methods do drug diverters use? 

There are numerous ways that drug diversion can take place. Healthcare staff can pocket medications intended for patients or take the waste medication home. Waste medication is extra medication left over after a delivered dose. These are just a few of the many ways it can take place in a healthcare setting and go undetected. At ECRI and our affiliate organization ISMP (a global leader in medication safety), we focus on educating organizations to reduce the risk of diversion by implementing strategies to make it hard to divert, make it more visible should a diversion occur, and should it happen, mitigate harm to self and others.   

What are the consequences of an individual doing this?

Drug diversion in healthcare settings is a serious issue with far-reaching consequences. It not only jeopardizes patient and workforce safety, but it also undermines trust in the healthcare system.

Sometimes drug diversion can deprive patients of the medications they need. They could receive incomplete doses, or no medicine at all. For healthcare providers, drug diversion can lead to compromised care and increased liability. Healthcare providers or staff under the influence of drugs can deliver unsafe care. 

There are also infection prevention implications, especially if a drug diverter is taking the medications themselves. Impaired providers and patients can become infected with HIV, hepatitis, and other diseases specifically associated with IV drug abusers. Providers could spread other types of infection due to viruses or bacteria, creating clusters and outbreaks of infections.

Beyond the human toll this problem can take, a healthcare organization will have a reputation crisis as well as financial penalties if a diverter has gone a long time without being caught. 

Addressing drug diversion is critical to ensuring the integrity of care, the safety of patients and staff, and the well-being of the communities we serve.

Can you share a few more thoughts with us on how infection prevention plays a role?

Infection preventionists should be part of a multi-disciplinary team, committee, or taskforce for the prevention of drug diversion. It’s important for facilities and infection prevention personnel to be on the lookout for epidemiologically related clusters of infections and links to diversion behaviors. Bring any concerns or findings to the task force for further investigation. In addition, strengthen outpatient surveillance activities, as many infections may be patient in their onset and not manifest while patients are admitted. Controls should be created by the committee or taskforce that cross many departments including but not limited to pharmacy, nursing, medicine, surgery, anesthesia, risk management, and clinical human factors engineers.

Are there any technologies that assist with stopping drug diversion?

There is useful data collected by medication-related storage and dispensing technologies that organizations should monitor on a regular basis. Auditing reports for automated dispensing cabinets and smart IV pumps have demonstrated useful in identifying suspected diversion. There are software programs that can be used with other electronic healthcare data to help organizations screen for potential diversion. Advances in hardware of medication-related devices have helped to make tampering more evident. Machine learning may also prove useful at strengthening targeted surveillance of infection data, especially in outpatient and other non-hospital environments.

Any tips for our readers about how to talk to your infection prevention team about this topic?

If the infection prevention team is not currently included in drug diversion prevention activities and working groups, ensure they are given seats at the table. Their experience in epidemiology and other disciplines is very valuable. Explain the benefits of identifying clusters and outbreaks and the importance of staying vigilant about drug diversion, especially if epidemiologic data shows there could be a link.