Drug diversion refers to the illicit use or abuse of prescription drugs by someone other than their intended recipient. In healthcare, this means the use of these drugs by healthcare providers, particularly physicians or nurses who have the most access to these substances.
Deemed an "epidemic" by the Centers for Disease Control and Prevention (CDC), the rising crisis of prescription substance abuse by healthcare workers should be recognized publicly and nationally. However, due to the amount of power and lack of oversight that doctors and nurses often have, this disturbing subject has been easy to overlook.
Physicians and nurses don't make up a significant number of drug abuse statistics. It was estimated in 2016 that 10% of nurses, 8% of doctors, and 15% of pharmacists struggled with drug (including alcohol) use or dependency.
Risks of Drug Diversion
There are many well-known negative aspects of drug abuse. However, drug diversion in the healthcare system by providers poses uniquely dangerous risks.
- Spread of disease — In particular, the spread of disease through drug diversion with injectable drugs is a rising issue. One of the worst recent outbreaks noted by the CDC was in 2012 when a radiology technician infected 45 people with Hepatitis C.
- Lower quality care — A physician or nurse who is under the influence of a prescription drug will not be able to care for patients to the best of his or her ability. On the other hand, their impairment will make them less able to respond quickly and accurately to the dynamic needs of a patient.
- Denial of necessary medication — When hospital staff divert drugs prescribed for patients, those patients are losing the vital medication needed to manage their conditions and pain while in the institution.
- Higher risk of malpractice — Both lower quality of care and the denial of necessary medication for patients by inhibited physicians or nurses are negligence. Negligence can lead to harm or the death of the patient. Both can result in malpractice lawsuits which can ruin both the doctor's and the hospital's reputations.
- Higher costs — Malpractice lawsuits have hefty sums, but the cost of drug diversion is a behemoth each year. It is estimated that the annual cost of drug diversion reaches $72.5 billion each year. This cost doesn't even include the lost labor productivity as the opportunity cost of drug abuse by hospital staff.
- Other consequences — Hospital staff that are found to have illicitly used drugs intended for other people may find themselves being fired, facing criminal prosecution, and losing their licenses.
Signs of Drug-Impaired Physicians
There are some actions doctors should be aware of when they are at work that signal impairment from hospital staff, including:
- Noticeable shifts in job performance
- Extreme errors
- Lowered alertness
- Excessive corrections of patients' health records
- Multiple long breaks
- Isolation from co-workers
- Reports of insufficient pain medication from patients
What Doctors Can Do
A number of health organizations, such as the Mayo Clinic and the Minnesota Department of Health, have made strides in addressing drug diversion as a serious issue today and in promoting strategies to alleviate it. There are a few steps that doctors should take to work against this epidemic.
- Raise awareness — Administrators who promote education of the negative effects of drug diversion as well as signs of it among all of their employees will lead to a healthier, safer workplace.
- Promote accountability — Promote policies that require drug disposal in twos or that other doctors have to be present for or sign off on prescription changes. These actions and others can make it less likely for hospital staff to get away with drug diversion.
- Increase security measures — Lack of oversight makes drugs very accessible for physicians, nurses, and other hospital staff. Adding cameras and even employee-to-employee surveillance programs (for the aforementioned signs) can decrease rates of drug diversion.
- Monitor all drugs — Though some pain medications and highly addictive drugs may be more likely to be diverted, all drugs are at risk for theft for economic or diversion benefit in general. Make sure that all prescription drugs are monitored, tracked, and documented across the board.
- Make resources available — It is important to treat substance abuse as a disease. Private practices and hospital administrations should make sure that resources such as hotlines, treatment programs, and counselors are easily available to hospital staff.