Bad Medicine: Drug Overdoses Are Rising, and So Is Drug Diversion in Healthcare Settings

While we need all hands on deck to fight COVID-19, we can’t relax our defenses against drug diversion within hospitals and pharmacies

By Russ Nix

When we think about drug overdoses or addiction, celebrities like Heath Ledger may come to mind, or perhaps a close friend or relative with a substance use disorder. But I think about the hospital floor—the doctors, nurses, and medical assistants in scrubs who work on the front lines, who are exposed to morphine, oxycodone, and other addictive substances every day.

One ICU nurse in particular, whom I’ll call Carol, frequently comes to mind.

Like all of her colleagues, Carol entered the nursing profession with a deep desire to help those who suffered, yet her own life was rife with suffering due to an abusive home environment. Work was her only escape—unfortunately, in more ways than one. We don’t know exactly what triggered her, but she started taking the excess Dilaudid® left over in syringes for personal use. Her behavior quickly grew more desperate, and she stole credit card information and patient identities to purchase prescription medications from pharmacies.

It took several weeks for investigators to gather enough evidence to apprehend her, but by then Carol had already racked up nearly 30 felony charges and faced a long, arduous path to recovery. I always wonder how her outcome would have been different, if we’d had the information, technology, and resources to stop her sooner. Would she have sought professional help? Could she have avoided a criminal record?

This is what drug diversion—any instance when a medication is diverted from its intended destination—looks like. It’s a huge problem in healthcare settings and has led to hundreds of outbreaks of healthcare-acquired infections like hepatitis C since 1999, according to the Centers for Disease Control and Prevention (CDC). It’s also led to fatal overdoses among several clinical workers. And, according to a 2019 survey of more than 235 healthcare executives conducted by Invistics and Porter Research, only 36% of healthcare organizations are “very confident” in the effectiveness of their drug diversion program.

With recent increases in drug overdose deaths in more than 40 states stemming from COVID-19, combined with potential disruption to the pharmaceutical supply chain, it’s not a leap to see that the healthcare industry is facing incredible risks related to drug diversion.

Incidentally, diversion of illicit substances isn’t the only risk we face when our preventive strategies—such as manual review of records and cameras, periodic cycle counts, or emphasis on clinical education—fall short. Over the past six months, we’re also seeing a rise in incidents of diversion of PPE, hand sanitizer, and other essential but limited supplies. We can only imagine what might happen when the coronavirus vaccine is ready for rationing.

But we don’t have to accept drug diversion as an inevitability. If we approach drug diversion prevention proactively, instead of reactively, we’ll be better prepared for subsequent waves of the coronavirus across the country. The solution for healthcare organizations begins with embracing accountability:

Review internal policies and procedures. As a narcotics officer, I was taught “where there are drugs, there are drug problems.” Hospitals, health centers, and pharmacies present an environment where the temptation for diversion thrives while carrying major consequences—including huge fines, medical malpractice litigation, and the spread of infection. Drug diversion policies should be consistent with regulations (e.g., more than one nurse should be present when disposing of “waste” or unused medications). The drug diversion prevention program should provide education and awareness, a cornerstone for effective cultural change.

Designate personnel to oversee drug diversion initiatives. Healthcare workers need to know that their organizations are taking drug diversion seriously, even though concerns over the pandemic abound. If there’s no one watching, it doesn’t matter what technology solution is in place. If an organization is wholly focused on COVID-19, clinicians might sense they’re not being watched and try to get away with diversion.

Research and invest in technology that can give you alerts within hours or days instead of weeks or months. Getting reports of possible drug diversion every 30–45 days means learning about diversion too late. Manual surveillance tools like security cameras are helpful but not sufficient in helping investigators quickly isolate patterns of diversion. Instead, leverage technology such as machine-learning software that can comb through multiple data sources to identify diversion indicators (e.g., whether a patient’s pain scores align with the dosage of a pain medication administered by a clinician). The sooner potential diversion is identified, the better off we all are.

The healthcare industry must also advocate for better, broader regulations. While laws continue to evolve as part of the opioid crisis battle, there is still a delay in effective response and prevention due to healthcare’s lack of awareness and accountability. Some of the major factors contributing to the industry’s drug diversion woes are a result of inconsistency in training, education, and awareness.

We must admit that America’s healthcare industry has a drug diversion problem. And addressing the problem head-on—rather than burying our heads in the sand—is the only way we’ll solve it for the long term.

Russ Nix is the founder and a consultant at Aegis RX. He serves on the board of advisors for, a nonprofit association dedicated to preventing drug diversion.