How do you Avoid Drug Diversion?

Reducing the risk of drug diversion in your facility requires not just knowledge of the problem, but the right tools and procedures that contribute to a safer drug disposal program in your facility.

According to the US Department of Justice National Drug Intelligence Center (NDIC), costs of drug diversion incidents affecting not only private medical insurers but to the public amounts to more than $72 billion a year.[1]

The potential for drug diversion by healthcare professionals increased during 2020 due to the stress of caring for COVID-19 patients in isolation scenarios, leading to the increased risk of seeking coping mechanisms through drug diversion. According to research, the increased influx of controlled substances to care for patients on ventilators requiring morphine, fentanyl, and/or codeine also increased access to those substances by healthcare professionals.

However, drug diversion activities are not limited to the COVID-19 pandemic. The issue has a long history and spans more than a decade. Introduction of new processes such as drug denaturing can prove beneficial in many situations when it comes to drug diversion methods, but as always, compliance with hospital pharmaceutical waste disposal processes is key.

According to the National Association of Drug Diversion Investigators, drug diversion is defined as “the transfer of a controlled substance from a lawful to an unlawful channel of distribution or use.”[2] Such activities define a wide scope of drug diversion activities among healthcare professionals, from taking a pill from a nursing home patient to writing fraudulent prescriptions, taking for personal use any medication destined for patients, diverting unused medications following the discharge or death of a patient, or otherwise stealing medication often used for pain management from patients.

How serious is drug diversion in healthcare environments?

How serious is drug diversion in hospitals and medical facilities throughout the country? According to statistics published by the Drug Enforcement Administration (DEA) in March 2021, approximately 70% of drug overdose deaths in 2018 involves an opioid.[3] Opioids, including hydrocodone, oxycodone, morphine, fentanyl, and others have wreaked havoc not only in the private sector, but among healthcare workers and employees.

The same publication states that hydrocodone and oxycodone have been the most prevalently diverted prescription drugs between 2010 and 2019. Millions of doses of medication have been diverted from patients by healthcare professionals in medical facilities throughout the country, and as such, clinical drug diversion is a serious issue that not only hampers quality patient care, but increases the risk of addiction, critical prosecutions, loss of licenses and reputation to healthcare employees and hospitals.

A number of drug diversion methods have been instituted in hospitals and other medical facilities around the country with varying degrees of success. Improving drug disposal processes can help to ensure that controlled substances are not diverted into the hands of nursing or physician staff. It has been estimated that approximately 17% of drug diversion incidents occur in long-term care settings.[4] This is due to a number of factors including the age of patients prescribed medications to control chronic pain and/or disease processes.

It is estimated that healthcare professionals are responsible for approximately 98% of drug diversion incidents, with the doctors being the most common diverters, followed by nursing staff.[5] While a number of factors are linked to such behaviors that include fatigue, stress, and emotional pain, it is the responsibility of management in any medical facility to appropriately train and educate employees, to have a drug diversion program in place, and appropriate drug diversion methods utilized in their facilities.

Compliance with hospital pharmaceutical waste disposal processes are also key in reducing drug diversion in any facility that stores, prescribes, and delivers a controlled substance to a patient. Opioids continue to be the most common when it comes to drug diversion (hydrocodone, oxycodone, and fentanyl), so safer drug disposal methods are highly encouraged for any healthcare environment.

Take steps to avoid drug diversion

A number of steps currently in place have attempted to reduce the potential for healthcare professionals to risk drug diversion from their place of employment, with mixed results. For example, some practices in place that may enhance such practices include but are not limited to:

• Requiring a witness to observe disposal of controlled substances
• Securing controlled substance infusions in locked infusion pumps (and requiring a witness for disposal after infusion is removed)

Nursing staff who dispense medications are already required to count meds pre- and post-shift as well as perform accurate documentation. While such processes do reduce the risk of drug diversion, they are not fail-safe.

Another step is to utilize sharps and pharmaceutical waste containers that are monitored by video cameras, and also taking steps to use lockable sharps and pharmaceutical waste containers. Such containers can also be secured in place to prevent easy removal from a med room, clinical unit, or area where drugs are stored. Limited access to keys for such containers is also a must.

Creating safe drug disposal

An important aspect of any drug diversion program is to ensure compliance in pharmaceutical drug and waste processes. The Food and Drug Administration (FDA), the Drug Enforcement Administration DEA), the Environmental Protection Agency (EPA), and other agencies, including state governments, provide guidance when it comes to compliant pharmaceutical waste disposal.

However, while standards, regulations, and rules are in place, it’s the identification and acknowledgment of drug diversion issues existing in a facility that provide the greatest benefits and options for creating effective drug disposal methods.

A drug diversion program can prove effective in reducing the risk such incidents in a healthcare facility, but many are not fully implemented. In some cases, management staff refuse to believe that such practices are occurring at their facility, while others erroneously believe that simple education on the topic is enough to prevent such incidents in their facility.

Lack of adequate financial resources are also an issue for hospitals dealing with budgetary constraints. Even so, an alarming 70% of hospital participants involved in a survey conducted by Invistics admitted that many incidents of drug diversion go undetected.[6] Creating pharmaceutical waste disposal processes and other drug disposal methods in a hospital or medical facility relies on awareness of the potential, if not an already existing problem, in the facility.

Development of new technologies for hospital pharmaceutical waste disposal are also an option and increasing in popularity. One such option is a process known as drug denaturing.

Drug denaturing

Of the many drug diversion program methods in place today is one that is effective not only in hospital environments, but in any location where drugs are dispensed or used, including pharmacies and home usage scenarios. When it comes to hospital pharmaceutical waste disposal, rendering a drug useless and irretrievable is also an effective option.

Such can be achieved by mixing a controlled substance or drug with a binding matrix or even water to dissolve or otherwise ‘ruin’ the drug, making it impossible to retrieve in the waste management process.

How does Secure a Drug work?

Neutralizing controlled substances is key in any drug diversion program. Secure a Drug is also an effective solution for denaturing not only for use in hospital facilities, but also any medical or healthcare provider. Such products are easy to use and are coupled with confidence in security. Using such technologies, it is possible to neutralize pharmaceuticals in a three-step process. Such containers come with secure and locked brackets that affix to a wall or sturdy structure to further reduce the risk of simply walking off with the container.

Simplicity of use is also a benefit. The container is filled with warm water. The locked cap is unlocked and then unscrewed. The drugs are placed into the container and the lid closed and locked once more. When filled, the container is collected by a waste management company that is approved and compliant and familiar with drug disposal and hospital pharmaceutical waste disposal processes.

Conclusion

Regardless of size or scope, every medical facility should be concerned with drug diversion. Recognition is key to improving processes and use of equipment and technology to reduce incidents. For more information about Secure a Drug, contact one of our representatives today.

[1] https://www.asisonline.org/security-management-magazine/articles/2020/09/drug-diversion-and-loss-prevention-a-changing-landscape/

[2] https://www.naddi.org/reports/2020-protenus-diversion-digest/

[3] https://www.dea.gov/sites/default/files/2021-02/DIR-008-21%202020%20National%20Drug%20Threat%20Assessment_WEB.pdf

[4] Ibid.

[5] Ibid.

[6] https://www.healthleadersmedia.com/clinical-care/many-hospitals-still-dont-have-drug-diversion-programs