Hospital Drug Diversion: An Underreported Threat

Health Care's Hidden Epidemic; Click to View

Perry Flowers, RPh

Katelyn Hipwell, PharmD, MPH

Results from a survey of 651 healthcare professionals indicate that many believe drug diversion within healthcare settings is a significantly growing problem and an underlying contributor to the ongoing opioid epidemic; however, identifying and combatting the problem remains a challenge. Only one in five respondents thought diversion was a problem at their facility.

According to the survey, “Health Care’s Hidden Epidemic: A Call to Action on Hospital Drug Diversion,” jointly conducted by global medical technology company Becton, Dickinson, and Company (BD) and global publishing opinion research consultancy KRC Research, much of the current information on drug diversion within healthcare settings stems from isolated cases and anecdotal evidence. The authors conclude that there are only inaccurate glimpses into the realities of drug diversion within hospitals. 

The survey results indicate that 85% of healthcare respondents are concerned about healthcare and provider-based drug diversion. Half of those who said they were concerned also confessed to witnessing a coworker’s suspicious acts, though few carried through with any reports. Interestingly, only 20% of healthcare provider respondents reported believing that diversion is a problem in their facility. 

Beyond providers, corporate management also suffers from the same “not in my back yard” biases, according to the study’s results. Among C-suite executives who participated in the study, 89% believe that substance abuse is a significant problem, but only 53% believe it is a problem within hospital settings. Furthermore, only 17% indicated that they believe drug diversion to be an issue within their particular hospital. 

Most hospitals already have drug diversion programs in place, but pinpointing instances of diversion is hindered by technological complications. Currently, raw data is collected from a variety of locations such as automated dispensing cabinets, electronic health records, and waste. Katelyn Hipwell, PharmD, MPH, pharmacy clinical operations manager for the University of Virginia Health System, says that hospitals can benefit from the application of technology that already exists. “Machine learning is enormous for us to help apply to this cause,” she says. “There are algorithms you can build that help us to assess all these data points and signals and learn from them, instead of having to only look at one stream of data and gather that data manually.” 

Similarly, Perry Flowers, RPh, vice president of medical affairs for Enterprise Medication Management, says that he would have healthcare providers and executives look at more formalized training and machine learning, and artificial intelligence that would find instances of drug diversion more quickly, while minimizing false-positives.

When combing through the data from various inputs, Hipwell says that she is primarily ensuring that all the transactions have been reconciled. Since humans are prone to error, she says, having one stream of data curated by a technology like artificial intelligence would be a major improvement. "That's what I'm really looking forward to,” she says, "something that can help us show the data in a way that combines all of the different avenues that we look at the data, decreases the time gathering the data, and decreases the time it takes to make these improvement efforts or investigations.” 

Kipwell also realizes that with the increasing use of technology to flag potential drug diversion, the possibility of false positives increases. A false positive that seems to be drug diversion could easily, for instance, be a miscalculation within an automatic dispensing cabinet. Though not indicative of diversion, Hipwell says instances like these are either due to a practice mishap or some other workflow issue that needs to be improved. Either way, the technology should benefit the eventual outcomes.

Healthcare thought leaders participated in a presurvey study and highlighted a few potential causes of drug diversion within healthcare settings. The most prominent cause is the demanding nature of the work itself, and the accompanying stress that healthcare providers experience. In combination, this presents a risky environment for providers, especially those with regular, immediate access to narcotics (ie, nurses, anesthesiologists, and pharmacists). According to the Bureau of Labor Statistics, there are over 300,000 practicing nurses and 30,000 practicing anesthesiologists in the United States, indicating a staggering potential for abuse. 

Though reports of drug diversion in healthcare settings remains low, thought leaders point to a combination of factors that may actually be inhibiting workers from coming forward. A recognized gap in training and communication, the social stigma attached to drug diversion and reporting the questionable behaviors of coworkers, and lagging technologies all contribute to a culture of potential suppression. 

During the presurvey segment of the study, thought leaders seemed to agree that diversion within healthcare settings is taboo among coworkers; however, 67% of executive respondents said that they believe their employees are comfortable talking about drug diversion at work, and 89% of participating providers said that they are at least somewhat or very comfortable discussing diversion with colleagues. 

Among the respondents who said that they would be uncomfortable discussing drug diversion at work, 67% believe that doing so sounds accusatory, 51% fear that it raises suspicions, and 40% believe that bringing up the topic engenders mistrust within their peers. 

Access the full report here.