Patterns of Diversion, Scope, Consequences, Detection, and Prevention. Abstract. Mayo Clinic has been involved in an ongoing effort to prevent the diversion of controlled substances from the workplace and to rapidly identify and respond when such diversion is detected. These efforts have found that diversion of controlled substances is not uncommon and can result in substantial risk not only to the individual who is diverting the drugs but also to patients, co- workers, and employers.
We believe that all health care facilities should have systems in place to deter controlled substance diversion and to promptly identify diversion and intervene when it is occurring. Such systems are multifaceted and require close cooperation between multiple stakeholders including, but not limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel, and human resources. Ideally, there should be a broad- based appreciation of the dangers that diversion creates not only for patients but also for all employees of health care facilities, because diversion can occur at any point along a long supply chain. All health care workers must be vigilant for signs of possible diversion and must be aware of how to engage a preexisting group with expertise in investigating possible diversions. In addition, clear policies and procedures should be in place for dealing with such investigations and for managing the many possible outcomes of a confirmed diversion. This article provides an overview of the multiple types of risk that result from drug diversion from health care facilities. Further, we describe a system developed at Mayo Clinic for evaluating episodes of potential drug diversion and for taking action once diversion is confirmed.
Abbreviations and Acronyms: ADM, automated distribution machine; CS, controlled substance; DEA, Drug Enforcement Administration; DDi. RT, drug diversion response team; HCW, health care worker; MDPC, medication diversion prevention coordinator; OR, operating room; PCA, patient- controlled analgesia“Diversion” means the transfer of a controlled substance from a lawful to an unlawful channel of distribution or use.
Uniform Controlled Substances Act (1. Diversion” means “Any criminal act involving a prescription drug.”National Association of Drug Diversion Investigators. In the United States in 2. The medication most often prescribed, 1. The opioid oxycodone combined with acetaminophen was prescribed 3. Although most of these sales resulted in the legitimate, targeted administration of pharmaceutical agents to patients, a fraction of the drugs manufactured and prescribed for patients are diverted for illicit purposes. Most drug prescriptions are for use in the outpatient setting, and, thus, most diversions of drugs occur there.
Instead of going before a judge, you have a chance to avoid trial and a record if you complete the terms of a diversion program. If you are a first-time offender and the crime is considered a minor infraction, you may be.
- The LEAD National Support Bureau responds to the national demand for strategic guidance and technical support to local jursidictions developing LEAD programs.
- The City and County of Denver’s website, denvergov.org, won first place in the City Portal category of the Center for Digital Government’s 2016 Best of the Web award competition.
- Office Overview : The Denver District Attorney's Office handles an impressive number of felony and misdemeanor cases each year.
- Drug Enforcement Administration (DEA) invites Maryland pharmacists to participate in upcoming Pharmacy Diversion Awareness Conferences (PDACs) in Towson, MD.
- San Bernardino Country criminal defense lawyer Michael Scafiddi is a former police officer now defending clients accused of felonies, misdemeanors or DUI.
This problem has been well documented in multiple publications and will not be further addressed here. Although a relatively small fraction of the nation's drug supply is administered in a health care facility such as a hospital or outpatient surgery center, the nature of these practices provides ample opportunity for drug diversion. This less appreciated form of drug diversion is associated with adverse consequences, the scope of which is incalculable, with harm to the drug diverter and others that is at times horrific. There are no available data that precisely define the extent of drug diversion from the health care facility workplace. However, it is well recognized that anesthesiologists, perhaps more than any other class of physician, have ready access to highly addictive psychotropic medications and have a higher rate of addiction to opioid drugs than physicians in other specialties. Furthermore, the drugs most commonly abused by anesthesiologists are obtained through diversion. Such data suggest that ready access is a critical component of drug diversion from the health care facility workplace.
The most common drugs diverted from the health care facility setting are opioids. Although other high- value drugs such as antiretroviral drugs, athletic performance–enhancing drugs (eg, erythropoietin and anabolic steroids), and nonopioid psychotropic drugs have been diverted from the health care facility workplace,7 the ensuing discussion focuses on the theft of controlled substances (CSs), defined as medications classified as Schedules II (ie, substances with high potential for abuse) through V (ie, substances with lower potential for abuse than substances in Schedules II, III, and IV), as defined by the federal Drug Enforcement Administration (DEA) and state statutes. We do not discuss the topic of theft within the pharmacy setting, which is largely accomplished by other means. Typically, drugs stolen from health care facilities are used to support an addiction of either the health care worker (HCW) or an associate and, less commonly, for sale for financial gain. This theft can be of unopened vials; vials or syringes that have been tampered with, resulting in either substituted or diluted dosages being administered to the patient; or residual drug left in a syringe or vial after only a fraction of the drug that has been signed out was actually administered to the patient. In addition, this theft can be of discarded syringes or ampules that have been properly disposed of in a “sharps” safety container.
In the outpatient setting, there is an elaborate system of checks and balances for prescription, procurement, and dosing of a CS. However, in the health care facility environment, vulnerability to diversion exists when a single provider, out of view of others, is free to engage in drug procurement from central stores, drug preparation, drug administration to patients, and/or disposal of drug waste. Given that CSs are often titrated to a desired effect in patients who may have widely varying drug requirements (eg, as a result of baseline individual variability, acquired habituation, or other factors), in the absence of sufficient controls, it is relatively easy for a single HCW, without the knowledge or collusion of others, to divert drugs intended for patients. It is beyond question that HCW diversion of opioids and other CSs from the health care workplace has occurred since time immemorial. Recent experience at Mayo Clinic and elsewhere have revealed that such health care workplace drug diversion creates numerous potential victims. Specifically, harm can come not only to drug diverters but also to their patients and co- workers and to the reputation of the health care institution that employs them. A recent devastating example is that of an infected HCW in the Denver, Colorado, area who, in the process of diverting narcotics for self- use, passed on hepatitis C virus to approximately 3.
Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention. Ian Danielson is a PhD Candidate in the University of Colorado Denver's School of Public Affairs. He has a BA in Psychology from Macalester College and MPAs in Policy Analysis and Economic Development from Indiana University's. King County's 'Best Workplaces for Waste Prevention and Recycling' list. All of these workplaces go beyond the basics to offer expanded recycling services for their employees. Part of the 'Recycle More.
Such cases provide graphic examples of why it is essential to reduce or eliminate opportunities for diversion of drugs in the health care facility workplace. Mayo Clinic has recently expanded its efforts to better educate its staff about the risks of drug diversion and to enhance its methods for detection. With encouragement from institutional physician- executives, we provide details of several instances that are instructive in alerting others to the sub- rosa crimes and harms that are likely occurring in health care systems worldwide.
In addition, we define the many potential harms and victims associated with drug diversion. We also review strategies that we have developed, and that continue to evolve, in our efforts to combat diversion. Potential Harm Arising From Drug Diversion. Addiction is sometimes viewed as a victimless crime. When the addiction is supported by drug diversion within the health care facility workplace environment, it becomes, in most situations, a multiple- victim crime in which patients, health care workers, and employers can be harmed directly or indirectly.
Harm to the Patient. In cases of drug diversion, patients may potentially receive substandard care from an addicted and drug- diverting individual.
If one assumes that the patients required the drugs that were prescribed for them, the absence of the drug entirely or dilution of the drug such that they receive a dosage less than that intended will likely result in the patient experiencing undue pain and/or anxiety, at least temporarily. This pain can be excruciating, as evidenced by the recent diversion of fentanyl by a sedation nurse in Minneapolis, Minnesota. While the patient was undergoing a surgical procedure, the nurse took most of the prescribed dose of fentanyl for herself, leaving the patient “in agonizing pain.” Immediately before the procedure, this nurse allegedly instructed the patient that he would have to “man up” and tolerate some pain because he could not be given much pain medication. This patient, a law enforcement officer, was so distressed by the care he received that he reported it to the police. In vignette 1, the harm was caused by a trusted visitor who volunteered to bathe the patient in order to steal the patient's opioids.
In vignette 2, the patient might easily have brought harm or death to herself by overriding the safety mechanism built into the PCA. In vignette 3, multiple patients likely experienced pain as a consequence of insufficient sedation and analgesia because they did not receive the analgesia that was ordered for their procedures. In vignette 4, 5 patients were infected with hepatitis C, and in 1 of these, the infection contributed to the patient's death.
Only in vignettes 5 and 6 was there no clear patient harm, yet the reckless actions occurring in vignette 5 exposed many other innocent HCWs, and possibly patients and visitors, to the danger of a needle stick injury with all of the attendant infectious risks of bloodborne pathogens.