Drug Diversion: Partially Filled Vials and Syringes in Sharps Containers Are Key Source of Problems

Unique dependency pattern

Studies have shown disproportionate misuse of prescription drugs by healthcare professionals when compared to street drugs, primarily because they can access prescription medications easily and often (Trinkoff, Storr, & Wall, 1999). Another pattern with healthcare workers is that drug abuse tendencies arise based on the drugs readily available to the worker (TheFoundingCrew, 2009). In addition to personal or family stress, dealing with patient illness, harm, death, an unpredictable work pace, heavy work demands, and long hours can make stress alleviation through drug use an attractive and convenient coping mechanism for healthcare providers (TheFoundingCrew, 2009; Dunn, 2005). These stresses have led many healthcare workers to use tobacco and alcohol as a legal way to relax and unwind after work. But reliance on these legal but addictive substances can be a “slippery slope” leading to prescription drug abuse and subsequent addiction (TheFoundingCrew, 2009). While some healthcare professionals have a misconception that their knowledge of the drug will help them “control” its use (Dunn, 2005), for many it’s a very short distance between misuse and dependence.


Risks to patients and workers

Drug diversion and abuse put patients at risk for suboptimal treatment from diluted or substituted medications, serious infections caused by contaminated needles and syringes, and errors committed by health professionals who are working while impaired. The toll can also be brutal for the impaired healthcare worker who is abusing prescription drugs (Eisler, 2014). Many healthcare workers feel guilt and despair, suffer physical and mental health issues, and may be indifferent to the risk of death from an overdose.


Safe practice recommendations

Systems for preventing and detecting drug diversion and dealing with workers who are battling a prescription drug dependency are clearly insufficient, given the current scope of the problem. Inadequate monitoring systems and lax controls leading to diversion also result in significant fines levied by the government (Dwyer, 2015). The real challenge is to strike a careful balance between recognizing addiction as a disease and taking steps to prevent patient and employee harm. Without getting into controversies that surround the debates about whether to apply a “crime and punishment” model of accountability for drug abusers, or to remove the stigma of drug abuse so practitioners who need treatment will seek it, the following recommendations, while not exhaustive, can help begin the long journey to a reduction in drug diversion and abuse.


Awareness and recognition of the problem

Expect diversion. Given that one in 10 healthcare practitioners/workers will abuse drugs, take all the necessary steps to prevent and detect it. No news is NOT good news when it comes to drug diversion and abuse.

Observe for signs of impairment and diversion. Educate all healthcare workers to recognize diversion and a drug-impaired coworker. Here are some signs and symptoms:


Changes in behavior (Dunn, 2005)

  • Increasing isolation from coworkers and social avoidance at work
  • Frequent illness, accidents, emergencies, tardiness
  • Complaints from others about poor work performance
  • Moody, depressed, irritable, suicidal threats
  • Frequent trips to the bathroom, locker room, unexplained absences, long lunches
  • Illogical or sloppy charting


Physical signs (TheFoundingCrew, 2009; Dunn, 2005)

  • Shakiness, tremors, slurred speech, sweating, unkempt appearance
  • Wearing long-sleeve clothing even in warm environments


Signs of diversion

  • Frequent incorrect controlled substance counts
  • Large or inconsistent amounts of wasted narcotics
  • Discrepancies between patient-reported pain and pain medication administration
  • Increase in the amount of drugs needed on the unit or in the pharmacy


Report suspicions. Establish an organizational expectation to report suspected drug diversion and worker impairment via a confidential process (e.g., hotline).

Educate about resources. Routinely provide staff education regarding the resources available if diversion is suspected or a practitioner wants to seek treatment for addiction.