Challenges of Drug Diversion in Health Care Settings Amid High Staff Turnover, Budget Cuts

Health care systems have spent the bulk of 2020 and 2021 adapting to new norms in workplace safety and patient care to minimize transmission of COVID-19, while effectively rolling out vaccines. It hasn’t been easy, given the economic tolls of the past year and a half, including high rates of clinical staff turnover at some facilities.

But amid this evolving post-pandemic “recovery,” health care leaders have devoted fewer dollars, and less attention, to drug diversion, according to a newly released report by Invistics and Porter Research. As many as 38% of health care and diversion professionals surveyed in early 2021 said resources for drug diversion investigations were reallocated due to budget cuts because of the pandemic, whereas 47% said drug diversion became more difficult to track due to staff turnover.

Also, only 45% of percent of health care organizations said they have at least 1 full-time employee (FTE) dedicated to drug diversion. This is a substantial drop from the 2019 report, which showed that 58% of organizations employed at least 1 dedicated FTE.

But with the risk of diversion potentially greater than it was before the pandemic, these data should be viewed as a warning sign.

Cases of drug diversion have steep financial, clinical, and legal consequences. Recent incidents of health care diversion have culminated in jail time for health care workers, the spread of healthcare-acquired infections (HAI) including hepatitis C, and massive monetary fines — not to mention reputational damage.

A Slippery Slope

Seventy-three percent of 2021 Porter Research survey respondents said they strongly agree that most drug diversion goes undetected, a number that has increased compared with previous surveys. And 86% said they personally know someone that has diverted medications.

Yet there is the tendency to ignore what’s not in front of us and hyper-focus on only the immediate problems we can see. For the last 18 months, COVID-19 concerns have understandably eclipsed nearly everything else.

But multiple circumstances are, nevertheless, building up to a perfect storm. Between October 2019 and October 2020, drug overdose deaths among the general population increased by about 30% over a 1-year period, amid the larger mental health crisis. Meanwhile, health care workers are exhausted: 65% of physicians polled recently noted that the pandemic increased their feelings of burnout.

Also, hospitals nationwide must still focus on COVID-19-related priorities, such as overseeing vaccine distribution. But this, too, has raised ancillary concerns around drug diversion: One in 3 surveyed by Porter Research said they are more concerned about drug diversion given the distribution of the COVID-19 vaccine.

More Machine Learning, Less Manpower

One silver lining in the data is the increased use of technologies that can identify drug diversion, and, in doing so, save organizations time and money.

Machine learning software, for example, enables technology providers to train machine learning systems to recognize known patterns of drug diversion in healthcare facilities. If, say, a hospital nurse dispensed 2 hydrocodone tablets from an automated dispensing machine but an hour later, the nurse reports in her electronic medical record (EMR) that she administered only 1 tablet, computer technologies would detect that the other tablet is missing.

More than 4 in 10 survey respondents (42%) said they use machine learning technologies to address drug diversion, up from 29% in 2019. Among those whose health systems use machine learning technology, 73% rated it favorably in effectively preventing diversion.

However, although the implementation of advanced technologies is encouraging, it’s only one solution. The issue of drug diversion is comprehensive and multifaceted. To successfully prevent diversion, or lower the risk, a health system needs leadership buy-in, staff cooperation, and potentially changes to hiring, education, and training practices.

Strengthening Operations

Given the ongoing risk of diversion, health care organizations would benefit from strengthening the following areas:

• Staffing: Having a dedicated professional to oversee systemwide initiatives around drug diversion — supply chain, investigations, reporting, IT purchases — is one of the best ways to bolster internal defenses. The fact that fewer health care organizations employed at least 1 full-time drug diversion professional may be to blame for a low level of investigations. In 2021, nearly 1 in five respondents (18%) respondents said they didn’t investigate any cases.
• Supply chain visibility: Health care organizations need systems in place to ensure that packages and goods are tracked from the moment they’re taken off the loading dock to their ultimate destination.

Education: Every health care facility should ensure its educational programming goes beyond informational sessions on substance-use disorders (SUDs). Educators must specifically address the risks and consequences of both drug abuse and drug diversion, including addiction, job loss, and legal ramifications.

Training: Most clinicians and pharmaceutical workers are trained on what to do when they encounter patients with SUDs. Ensure clinicians and staff also understand the process of reporting a suspected incident of diversion, or suspicious activity. Organizations like HealthcareDiversion.org, the National Association of Drug Diversion Investigators (NADDI), and the International Health Facility Diversion Association (IHFDA) offer resources to educate and train staff on drug diversion prevention best practices.

Technology. Eighty-six percent of health care leaders already utilize automated dispensing cabinets. But for maximum benefits, the data derived from technology solutions like automated dispensing cabinets (ADCs) should be integrated with other data sets. For example, machine learning software can synchronize multiple sources of information — electronic health records, patient pain ratings, pharmaceutical records — from disparate sources, and dispatch alerts when patterns associated with diversion are detected.

Although health care organizations need to keep their focus on patient care and safety amid the ongoing pandemic, they also need to prepare for increased risks of medication theft and misuse. With the current state of declining hospitalizations of patients with COVID-19, now is the time to take another look at the protocols, policies, and technology used to reduce drug diversion.