Diversion and Substance Abusing Healthcare Professionals

The diversion of drugs in hospitals, skilled nursing facilities, assisted living communities and other care centers is a serious problem in health care today. This activity involves stealing, removing or “wasting” prescription medications, including opioids, from one’s place of employment. The drugs can be consumed onsite, taken offsite and used later, or sold. Diversion is a part of the larger opioid addiction problem in the United States and many health care professionals must take mandatory annual education on the subject to maintain their license.

Scope of the Problem

Substance abuse is the main reason for disciplinary actions against nurses by state boards. The American Nursing Association indicates up to 10% of nurses are drug dependent. But, nurses are not alone. It is estimated that 8% or more of physicians and 15% of pharmacists divert and abuse prescription medication. Anesthesiologists, hospital administrators, med techs, orderlies and other employees in health care settings are also likely to engage in this activity. Tens of thousands of professionals illegally remove prescription medications from their workplace and some will be impaired while providing care during their shift.

Why Don’t We Hear About This?

Despite the amount of diverting taking place across the country, most of us will not hear about it or see it in the news. Why is that? Most facilities will do their best to hide or cover up any information about an incident of diversion. Reasons for this range from shame to fear of negative publicity. When a story of diversion breaks, it can seriously damage a facility’s reputation and the bottom line. Fear also stems from any state or federal agency involvement.

Commonly Stolen Drugs

While almost any kind of prescription medication can be illegally removed from a healthcare facility, there are those which are more commonly taken. Fentanyl appears to be a popular target, mainly for its effectiveness, powerful high and short duration. It is also one of the most dangerous drugs due to the possibility of addition and overdose. Other opioids are diverted including Codeine, Oxycodone, Morphine, Percodan, Percocet, Dilaudid and Darvocet. Some health care professionals don’t want the “downer” effects of these drugs and seek amphetamines instead. Others divert barbiturates or benzodiazepines.

The type of drug stolen is usually associated with symptoms of pain, depression or anxiety. They may be used to support a pre-existing addiction or less commonly, drugs are diverted to be sold for financial gain. Regardless of the reason, many health care professionals experience real pain and innocently begin treating their symptoms. Some will become addicted to pain medications. Once they can no longer obtain them legally through a physician’s prescription, they may turn to stealing them from their workplace. Some will take these drugs at work, on their shift, and provide care that can be described as “impaired”. This is a frightening and dangerous problem.

Signs of Diversion

While most employees may never notice anything unusual at work, there are a number of behaviors that can be evidence of diversion. Here are a few:

• Constantly volunteering to be the medications nurse
• Often signing out more controlled substances than co-workers
• Frequent administration of controlled drugs
• Frequently reporting medication spills, non-administered or partially administered medications
• Failing to obtain co-signatures
• Reports reflecting excessive use of PRN medications
• Discrepancies in end-of-shift medication counts
• Reports of the nurse waiting until no one is around to open the narcotics box or cabinet

Final Words… And Questions

Diversion of prescription drugs from health care facilities is a real and dangerous problem. It is also unethical and illegal. While the individual stealing drugs suffers from dependency or addiction, how much does the patient suffer when necessary medications, especially pain medications, are not administered? How much does this problem cost health care? How many lives are ruined because of the ability to take any substance one wishes from their place of employment?

More About Substance Abuse

• Diversion and Substance Abuse: Risk Factors and Symptoms
• Diversion and Substance Abuse: Suspicious Behaviors in the Workplace
• Death by Heroin: Ohio’s Heroin Epidemic