Diversion of Prescription Medications: Suspicious Behaviors in the Workplace

Diversion of prescription medications in healthcare facilities takes place on a daily basis. They are being “diverted” by doctors and nurses, who are assisted by other colleagues and co-workers. Despite this taking place frequently and regularly, it largely goes unnoticed by anyone. While systems and policies are being put in place to reduce or stop this activity, diversion of prescription medications continues to be a real and dangerous problem in health care today.

Why Diversion of Prescription Medications Happens

Health care is stressful. Healthcare professionals are regular people who are exposed to many physical and emotional demands. They can also be traumatized by experiences, patients and the job itself. Some will experience pain and bodily discomforts associated with their roles. Others are dealing with depression, anxiety or other emotional disorders.

Even though healthcare professionals are regular people, they do have an advantage that most do not – they have extensive knowledge of prescription drugs. They are aware of the strength of medications and their side effects. They know how to administer drugs in a multitude of ways. Healthcare professionals also know how long the effects of a medication will last and how to hide their signs and symptoms.

Some healthcare professionals may have a great sense of control. After all, they are doctors and nurses. If they don’t have control, who does? Some believe they must be Superman or Superwoman. Others are simply high achievers. Even though they may think or feel this way, at the end of the day they are still people who are vulnerable to substance misuse, dependency and addiction.

Other reasons for diversion exists include stress at home, relationship problems, dysfunctional coping, working in critical care, working the night shift, having agency staff in the building, and being a smoker. Diversion can start as a one-time, isolated event and can progress into a full-blown addiction without the user, or anyone else, ever being aware. It can begin as a way to self-medicate pain and end in tragedy.

Suspicious Behavior in the Workplace

Although most people don’t notice anything unusual at work, there are many behaviors to be aware of concerning the diversion and consumption of substances. Here are a few:

• Absence without reliable explanation
• Tardiness
• Inappropriate behavior
• Disorganization
• Increased conflicts at work
• Avoidance
• Long lunches
• Unnecessary or frequent breaks

Nurses may order larger than normal quantities of certain medications or the orders may be inappropriate. They may also forget verbal orders. The professional may drink heavily at work functions, take long lunches, or unusually long and frequent breaks from work. Perhaps, the nurse takes excessive amounts of time in the med room. Some will disappear from work altogether.
Nurses may also “waste” a lot of medications by dropping them on the floor or damaging them. Vials and drug containers may appear to be tampered with or altered. There may be patterns of medication discrepancies during specific shifts. Narcotic counts may be off. Co-signatures may be missing.

Documentation usually suffers after a while, in both content and clarity. Uncharacteristic deterioration of handwriting and charting can be signs of substance abuse. Work performance may decline. Mistakes and poor decisions can be made. Ordinary tasks become increasingly more difficult to accomplish.

Final Words

There are many reasons why diversion takes place in health care. There are also many signs and symptoms to look for in the workplace. Healthcare professionals are regular people who face a number of stressors and have access to prescription drugs in the workplace. Because of this, they are in a unique position to divert substances for their own use or to sell. This is a major problem and it doesn’t seem to be going away. What can you do to become more aware of diversion in your facility and what will you do about it?

More About Substance Abuse

• Diversion and Substance Abuse: Risk Factors and Symptoms
• Diversion and Substance Abusing Healthcare Professionals
• Death by Heroin: Ohio’s Heroin Epidemic