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Drug Diversion Defined: A Patient Safety Threat

Categories: Healthcare-associated infections, Injection Safety

Kimberly New, JD BSN RN

Kimberly New, JD BSN RN

Guest Author: Kimberly New, JD BSN RN
President, Tennessee Chapter of the National Association of Drug Diversion Investigators

You may have seen some recent media reports about drug diversion. Today, I want to break down the issue of drug diversion and provide some details about this serious patient safety threat.

Drug diversion, or theft of drugs, by healthcare personnel poses a continuous threat to patient safety in any healthcare setting in which controlled substances are handled. Although personnel who divert originally went into healthcare to care for patients, they have made poor choices for which they are accountable, including the impact their actions have on others. The longer a healthcare worker is allowed to steal medication, the greater the consequences become. Impaired providers can harm patients by providing sub-standard care, denying medications to patients, or exposing patients to tainted substances.

Tampering is the worst type of diversion. Commonly, the diverter removes medication from a syringe, vial, or other container and injects him- or herself with the medication. The diverter then replaces the stolen medication with saline or sterile water, or another clear medication or liquid. The “replacement liquid” is later used on the patient by an unaware provider. When tampering, the diverter may rarely use sterile technique. Ultimately the patient doesn’t receive the required medication and may be exposed to the diverter’s blood.

It’s as if the patient and the diverter are sharing needles. Any bloodborne infections, such as hepatitis C, that the diverter has been infected with can be passed on to the patient, even though they may be asymptomatic.

Even individuals who are not patients may be placed at risk as a result of diversion by a healthcare worker. For example, they may be harmed by a worker who is driving in an impaired state. It is not uncommon for workers to self-administer diverted narcotics while leaving their workplace. In one case, a diverter left her shift, drove home in an impaired state, and caused a head-on collision when she went the wrong way on an Atlanta highway.

Diversion is a scary, often unspoken threat to patient safety. Lately, there has been a trend towards transparency to highlight this problem. In my next blog, I am going to discuss how diversion negatively impacts hospitals and other healthcare facilities.

In the meantime, let me know your thoughts.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. AUTHOR COMMENT June 5, 2014 at 6:42 am ET  -   CDC's Safe Healthcare Blog

    Drug abuse is certainly a large public health issue. In our recent article in Mayo, we are looking at drug diversion and its impact on patient safety. Read more here: http://www.cdc.gov/injectionsafety/drugdiversion/index.html

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  2. AUTHOR COMMENT June 5, 2014 at 6:41 am ET  -   CDC's Safe Healthcare Blog

    Thank you for sharing your experiences!

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  3. AUTHOR COMMENT June 5, 2014 at 6:41 am ET  -   CDC's Safe Healthcare Blog

    Sue, you have some great points—thank you for bringing them up!

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  4. AUTHOR COMMENT June 5, 2014 at 6:40 am ET  -   CDC's Safe Healthcare Blog

    We are so sorry to hear about your mother. It is tragic how many patients are impacted by events such as these. Read a recent blog from another patient impacted http://blogs.cdc.gov/safehealthcare/2014/05/30/cancer-survivor-employs-simple-steps-to-fight-off-infection-during-chemotherapy/

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  5. AUTHOR COMMENT June 5, 2014 at 6:40 am ET  -   CDC's Safe Healthcare Blog

    You are right. This is an issue that happens in the shadows. But it is certainly no joke. See our new website with a list of recent outbreaks. We think this is the tip of the iceberg. http://www.cdc.gov/injectionsafety/drugdiversion/index.html

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  6. June 4, 2014 at 6:39 am ET  -   Joan G. Promin, B.S., CCRC, CCRA

    You have called our attention to a serious existing problem. The solution is that the persons in charge are unaware of the problem.
    Physicians in small practices trust their staff members. Afterall, they’ve selected and hired them. In addition, the usual M.D./D.O. simply wants to “practice medicine”. In larger medical groups, the Office Manager is in a similar position: They have selected and hired the staff. Therefore they want to trust those folks.
    Only after another staff member alerts management (or the physician in charge), can this “diversion of drugs”, or misuse of medications be identified and rectified. In Clinical Research, we lock our Investigational Product, keep daily logs on what has been dispensed, and are accountable for all drugs in our various studies.
    So, one solution might be to lock and log all medication.

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  7. June 4, 2014 at 1:44 am ET  -   Dennis Dowd

    No one really wants to deal with this issue. How it plays out in our society is similar. We approach all this with a fairly non-supportive and negative approach. Surely the stress of working in the medical field is something everyone wants to avoid discussing. Our own culture’s approach is the “War On Drugs” which has become a business in itself. We have used drug addiction to take away people’s rights and their property. “Prohibition of Alcohol” has surely shown us that this approach doesn’t work, and the failure of the war on drugs is also another example. This issue is surely much larger than this article wants to address. I actually feel this article is almost a joke in itself, though I feel the author is serious about it and the information is interesting. But surely this article and its information will do nothing to change out come of drug use in healthcare or any where else. There is allot that the medical culture can do to change things but they will never be done.

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  8. June 3, 2014 at 5:27 pm ET  -   D.phelps

    My mom died because of this problem. She was in aweful pain and in the rehab she was sent to for hip replacement they stole her pain meds and left water on the floor in front of her bed on purpose. No one has time to fight the battle but it killed my mom…it is very sad. The health care system needs some serious Reveiw.
    Thanks for listening.

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  9. June 3, 2014 at 4:40 pm ET  -   Sue

    The impact on the patient are not only acquiring Hepatitis C or other bloodborne infection, but also the patient would not receive relief from pain if that was the purpose of the medication. It would then be reported to the physician who may choose to increase the dose of the medication for the convenience of the divertor HCW. I have investigated drug diversion in which the patient has documented by the divertor the maximum amount of the drug allowed (i.e. q4h), thus causing the patient to be labeled an abuser. Finally, consider the financial impact on the patient…being charged for every documented dose of the medication. The patient may not have insurance, have limitations on usage of the medication, or be denied refills of the medication. Payment could also effect payment of Medicare, Medicaid or other 3rd party payer.

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  10. June 3, 2014 at 3:59 pm ET  -   Timothy

    I am a Staff Development Coordinator, as my role here I have had to deal with a couple of nurses who decided to devert narcotics for thier own use. We have a strict narcotic control program, it did not take long to catch them in the act. I had to terminate these people, which left me short A nurse for the shifts that she worked, which impacts all of the residents that she had to take care as well as the staff that she was to suppervise, and the damage to the resident who did not recieve the pain control that was needed, and needlessly suffered. The cost to our facility due to this neglect ads up in dollars, lost time, it cost to hire and train a replacement, the cost in moral to the staff member who had to report the missing narcs. The time and effort I and the DON had to put in doing paper work, the cost of a random drug screen. This behavior does need to stop. it has only happened here twice, but twice is to many times.

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  11. June 3, 2014 at 2:32 pm ET  -   mohammad ashori MD

    Thank you for the article. Are you stating that drug diversion by definition involves a health care personnel? I may have misunderstood but it might be pertinent to give a more general description. Drug diversion involving health care personnel no doubt is a patient risk but it is likely a small percentage of all drug diversion cases.

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