Special article
Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention

https://doi.org/10.1016/j.mayocp.2012.03.013Get rights and content

Abstract

Mayo Clinic has been involved in an ongoing effort to prevent the diversion of controlled substances from the workplace and to rapidly identify and respond when such diversion is detected. These efforts have found that diversion of controlled substances is not uncommon and can result in substantial risk not only to the individual who is diverting the drugs but also to patients, co-workers, and employers. We believe that all health care facilities should have systems in place to deter controlled substance diversion and to promptly identify diversion and intervene when it is occurring. Such systems are multifaceted and require close cooperation between multiple stakeholders including, but not limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel, and human resources. Ideally, there should be a broad-based appreciation of the dangers that diversion creates not only for patients but also for all employees of health care facilities, because diversion can occur at any point along a long supply chain. All health care workers must be vigilant for signs of possible diversion and must be aware of how to engage a preexisting group with expertise in investigating possible diversions. In addition, clear policies and procedures should be in place for dealing with such investigations and for managing the many possible outcomes of a confirmed diversion. This article provides an overview of the multiple types of risk that result from drug diversion from health care facilities. Further, we describe a system developed at Mayo Clinic for evaluating episodes of potential drug diversion and for taking action once diversion is confirmed.

Section snippets

Illustrative Vignettes

There are many patterns of drug diversion in the health care facility workplace environment, involving personnel from diverse backgrounds engaged in diversions in a variety of practice locations. The heterogeneity of drug diversion practices is exemplified in the following vignettes, all based on cases detected at Mayo Clinic medical centers during 2010 and 2011. These vignettes represent only a portion of the instances of diversion that were detected during that time. For reasons of

Potential Harm Arising From Drug Diversion

Addiction is sometimes viewed as a victimless crime. When the addiction is supported by drug diversion within the health care facility workplace environment, it becomes, in most situations, a multiple-victim crime in which patients, health care workers, and employers can be harmed directly or indirectly.

General Concepts of Prevention and Detection

Many HCWs are unaware that drug diversion is a serious problem in the workplace. Thus, broad-based educational efforts must be instituted that focus on the nature and scope of the problem, signs and symptoms of possible diversion and addiction, and proper ways to respond if diversion is suspected. The entire workforce, not only those with ready access to CSs, should be informed of the threats to life and career presented by drug diversion. Orientation of new employees should include such

Department of Anesthesiology

Anesthesiologists and nurse anesthetists are health care providers in whom psychotropic drug use and addiction is considered an occupational hazard.6, 13, 16 Mayo Clinic is no exception in this regard; thus, it is not surprising that concerted efforts to detect drug diversion began in the Department of Anesthesiology. Detection has often been precipitated by personnel underperformance or behavioral changes at work, frequent unexplained work absences, patients who seem to be undermedicated in

Conclusion

Diversion of drugs from legitimate to illicit use is being recognized with increasing frequency in the United States. Although the full extent of diversion from health care facilities is unknown and probably unknowable, our experience makes clear that it is a considerable and ongoing problem. Addicted HCWs who are diverting drugs from the health care facility workplace pose a risk to their patients, their employers, their co-workers, and themselves. It is essential that all health care

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