Improving Diversion Reporting Through Shared Best Practices

By Matt Phillion

Drug diversion incidents remain a problem throughout healthcare, where an estimated 10% to 15% of all industry professionals misuse drugs or alcohol. Through the nonprofit Healthcare Diversion Network’s website HealthcareDiversion.org, 684 diversion incidents have been reported across all 50 states, and while most incidents happen in hospitals, pharmacies have also seen an influx.

Reports to the site are verified and input into a database, displayed on a searchable map to help providers hire more effectively, improve provider accountability, and assist patients in avoiding risky providers. The network strives to prevent drug diversion, which can lead to addiction, drug overdose deaths, and the spread of infectious diseases, undermining the integrity of the healthcare system.

“Sadly, it’s happening a lot, but if we’re looking for a silver lining, a lot of facilities are adopting policies to reduce diversion to help decrease the frequency and number of victims,” says Tom Knight, founder and chairman of the Healthcare Diversion Network.

When he first entered the field, Knight notes, the challenge was largely around awareness. Some facilities understood the risk to patients and colleagues caused by diverting resources, but they were in the minority, he explains.

“Today, nearly all organizations are starting to understand the risks of not having the ability to prevent and predict diversion. There’s more awareness about the potential for serious problems and financial harm,’” says Knight.

It’s happening everywhere you encounter these drugs, Knight explains—not just hospitals but nursing homes, skilled nursing facilities, pharmacies, and beyond.

“We’re also seeing more diversion of non-controlled substances,” Knight says. “These drugs are extensive and there is a black market for them.”

Of the organizations impacted by drug diversion, hospitals are frequently positioned better than others to detect and address diversion, Knight notes.

“They’re invested in automated dispensing cabinets, they’ve invested in EHRs, they’re charting electronically,” he says. “That provides data that could detect diversion that might not be available in another type of organization.”

Where to report diversion

While the database Healthcare Diversion Network reports into is an important resource, Knight notes that their organization is not necessarily the most important place where drug diversion should be reported.

“It’s essential that when a diversion is detected, it is reported to the appropriate authorities,” says Knight. “We build a large and growing database, but we’re not the right people to report to if a hospital or other kind of organization suspects diversion is happening.”

Organizations are required by law to report to different organizations depending on what type of diversion is occurring.

“If it’s a licensed clinician like a nurse, a doctor, or a pharmacist, for example, you have to report to their licensure board, typically at the state level,” says Knight. “And if there’s a crime involved, you have to report that crime to law enforcement. And if there’s tampering [with the drug/dosage] involved, that’s a federal crime and must be reported to the DEA.”

And if there’s a chance the patient is injured—for example, the person diverting the drug has a bloodborne pathogen and is sharing the needle with the patient—that needs to be reported to the local department of health.

“So, the number one thing an organization can do is report,” says Knight. “If they fail to report, and they quietly fire the person, that person can go across town and work at another community facility. It’s important to report not only so that the diversion stops, but also so that person can get the help they need with their substance abuse disorder.”

Failure to report just keeps the problem moving to another facility.

“If I’m the only hospital reporting and all the other hospitals are just firing without reporting, that just kicks the can to someone else. Everyone needs to report, and that way we’ll hopefully see less likelihood of diverting in the first place,” he says.

There are very human reasons why people may not report drug diversion, though. If they feel the incident is only going to be treated as a law enforcement issue and the person may be facing jail or punishment, individuals may be reluctant to report.

“They care about their colleagues,” Knight says. “We’re seeing positive trends that states are offering alternatives to discipline. If they self-report, for example, there are ways to bypass the law enforcement discipline people would be scared about.”

There are also positive trends in getting people the help they need through recovery groups, peer assistance programs, and other options to help with the underlying issues.

“This can be a good engine to get more organizations to report,” Knight says.

The road to improvement

People working in healthcare facilities care about their colleagues, and to get to the next level of improved reporting, there should be an educational path that helps them realize the best thing they can do is report drug diversion to their leadership, Knight explains. It should also be clear that those leaders will take the right steps to confidentially investigate the report.

“Ignoring the problem is going to lead to more abuse, which can lead to more tolerance, which can lead to more disorders, and then make it that much harder for their colleague to recover,” says Knight. “We need to educate folks about how it’s better to report than look the other way.”

This is why organizations like the Healthcare Diversion network focus on raising awareness of alternatives to discipline.

“Nobody starts to divert saying, ‘I hope I become addicted,’” Knight says. “These are powerful drugs, and someone who diverts for self-use is very likely to develop a disorder, so the sooner we can intervene, the sooner they get the help they need.”

There are lot of stakeholders on this front, which was part of the genesis of the non-profit network. On the private side, leaders need to step in the right direction and communicate why this is an important issue, while on the public side, state and federal regulators, licensure boards, and more all own a piece of the solution.

Knight has seen encouraging developments on the public side, with his organization working with states to collect model drug laws for states to adopt so they’re not reinventing the wheel but rather learning from the successes of other initiatives.

“This is in collaboration with one of our advisory board members. They’ve written model laws in a variety of areas and are hoping by sharing them, states that don’t already have best practices can adopt from these,” says Knight.

Knight also points to excellent work by other nonprofits in this area providing education and best practices around drug diversion, including the International Facility Health Diversion Association and the National Association of Drug Diversion Investigators.

“They’re hosting conferences and getting folks from both the public and private sectors to share their best practices, and we’re enthusiastic supporters,” Knight says.

Organizations aren’t just protecting their patients and staff by investigating and reporting drug diversion, they are also protecting themselves.

“There are penalties that these organizations suffer if they fail to do the right thing,” says Knight. There are fines from the DEA if an organization fails to comply with the Controlled Substances Act, and frankly, the DEA has done a good job issuing large fines when facilities are particularly negligent.”

There’s also the tragic side of not acting in an appropriate manner—when patients are injured due to diversion, the lawsuits add up financially.

Much of improving reporting is equipping staff with a confidential and trusted way to report their concerns.

“If I’m a clinician and I’m made aware of a diversion happening around me and I have knowledge why reporting someone is good for that person and I trust that reporting will be done confidentially without damaging their reputation, I’m more likely to report,” says Knight.

One point of interest Knight notes is that most of the time when someone reports to their site, the incident is already public knowledge. But some reports come from concerned healthcare workers who might have reported to a supervisor and nothing has been done.

“Those cases are really challenging, and some states have partnered with us and asked if we receive those reports, they’d like to investigate,” says Knight. “We’ve seen that not every facility is doing what it needs to. We’re glad people are reporting, but we wish that reporting to their local facility was sufficient.”

Two things need to happen to improve diversion reporting at a faster rate, Knight says.

“We need to share best practices for preventing and investigating diversion. That’s largely on the private side,” he says. “And on the public side we really have a patchwork of laws and regulations, with some states that are strong, and some are weak in different areas. We should adopt the best practices across the country so that diversion is more likely to be detected and reported.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.