Tom Knight, MBA, MS

In the US, health care leaders are so overwhelmed by the clinical, operational, and financial aspects of managing coronavirus disease 2019 (COVID-19) that they may be less focused on stopping drug diversion. But it is still happening. In many parts of the country, opioid-related overdoses are rising while health care workers on the front lines are reporting higher levels of mental health issues. Meanwhile, the supply of coronavirus treatments, within a strained economy, could increase their black market value.

Yet the biggest signs of the potential for drug diversion to skyrocket in health care environments may be within the hospitals themselves, which have been forced to quickly adapt to the COVID-19 era.

Since March, the spread of COVID- 19 has fueled a higher sense of urgency in health care centers, from the movement of nurses from one hotspot area to the next to related increases in patients with high-acuity needs. This has led to the implementation of new rules, workflows, and guidelines, to ensure that contact with high-risk individuals is minimized, personal protective equipment is appropriately rationed, and frontline workers receive the support they need. Although these operational shifts were necessary, they have exposed new vulnerabilities in care settings.

Here are 5 tactics health care leaders can employ to improve their efforts in stopping drug diversion:

Clinical leaders are already having conversations about drug diversion, but it is important to keep the issue top of mind among clinicians.Sharing news of recent incidents highlights not only the theft of COVID-19–associated supplies,but also the criminal consequences.

 If the physical layout of a health facility was modified in response to COVID-19, clinicians may need to be retrained on adapting medication management practices to a new environment. For example, Drug Enforcement Agency guidelines require that unused controlled substances must be destroyed following strict rules, so clinical supervisors may need to take extra steps to ensure compliance.

Discrepancies in data,such as patient pain scores,
may indicate the need for a diversion investigation. Case in point: In May, an Iowa nurse anesthesiologist was sentenced to 34 months in prison for tampering with vials of fentanyl in a hospital’s surgery
and birthing center. But the nurse’s drug problem was only discovered by accident when a hospital visitor caught him sleeping. Only when authorities reviewed his obstetrics patients did they learn that
1 in 4 of the nurse’s spinal anesthesia patients had received narcotics that were insufficient to reduce labor pain. Had a red flag been raised sooner, the perpetrator would have potentially been investigated more quickly.

 A dedicated drug diversion professional, used
on a part-time or full-time basis, can assess a health care facility’s current approach and solutions to mitigating drug diversion and identify gaps. Yet according to a 2020 study conducted by Porter Research and Invistics, just 41% of health care organizations have at least 1 dedicated diversion professional on site.

 Considering that only 36% of workers surveyed said they are confident in their organization’s drug diversion program, having an expert available to support efforts to improve drug diversion could be a game changer.

 In addition to having visibility into the supply chain, it is important to have visibility into other areas, including health care workers’ experience and background, adjustments in the workflow, and so on. A health care organization may want to consider using technology (eg, track and trace software) or increasing the number of audits it performs on a regular basis.

, the leading provider of inventory visibility and analytics software solutions. Prior to founding Invistics, Tom spent 10 years improving supply chains as a manufacturing manager at Alcoa and Siemens. Tom has a B.S. and M.S. in Mechanical Engineering and an MBA from Massachusetts Institute of Technology (MIT).

Issue brief: reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic. American Medical Association. Updated October 31, 2020. Accessed November 9, 2020. 

https://www.ama-assn.org/system/files/2020-11/issue-brief-increases-in-opioid-related-overdose.pdf

Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic: a review. 

 2020;51:102119. doi:10.1016/j.ajp.2020.102119

Drug disposal information. US Department of Justice, Drug Enforcement Administration Diversion Control Division. Accessed November 9, 2020. 

https://www.deadiversion.usdoj.gov/drug_disposal/index.html

Charles City nurse anesthetist sentenced to nearly three years in federal prison for drug tampering and diversion scheme. News release. The United States Attorney’s Office Northern District of Iowa. May 29, 2020. Updated June 1, 2020. Accessed November 9, 2020. 

https://www.justice.gov/usao-ndia/pr/charles-city-nurse-anesthetist-sentenced-nearly-three-years-federal-prison-drug#:~:text=West%20was%20sentenced%20in%20Cedar,%243%2C158.18%20in%20costs%20of%20prosecution

Porter Research Study 2020: A Comprehensive Look at Drug Diversion from the View of Healthcare Executives. Porter Research. Accessed November 9, 2020. http://porterresearch.com/wordpress/wp-content/uploads/2020/05/Invistics_Diversion-Report-2020-Porter_Research.pdf

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Incidents of medication theft, including theft of COVID-19 treatments, could jeopardize operations and hurt patients.