Drug Diversion and Leadership Response: Tips for Supporting Staff, Patients

Drug diversion is a problem that not only affects patients but also the health care worker doing the diverting. The patient may receive suboptimal drug therapy and experience adverse drug reactions from adulterated drugs. Similarly, the health care worker diverting the medication is at risk of facing legal and regulatory problems and is also at risk of addiction, overdose, and, worse, death. Leadership needs to have a process in place for identifying and preventing drug diversion. They also need to be prepared to provide support and resources for staff and patients affected by drug diversion. 

The Community/Ambulatory ISMP Medication Safety Alert published October, 2022, outlines 5 different methods that organizations and leadership can use to prevent drug diversion and support staff who might be diverting medications. 

#1 Promote a Culture of Safety

Leadership should embrace a culture of safety when it comes to controlled substances. The goal should be to create a safe and open work environment that is appropriately staffed in relation to the workload. This will help to prevent unnecessary stress and burnout from staff. Regarding individuals diverting medications, the focus should be on helping them recover and providing aid as opposed to a punitive approach. For example, leadership should offer employee assistance programs that struggling staff can easily access as needed. 

#2 Educate Staff

Organizations should provide initial and annual staff education regarding controlled substances for those who handle them. The education should include tips about how to handle controlled substances to prevent diversion, how to recognize and report signs of drug diversion, and what resources are available to help those who need assistance. 

#3 Safeguard Controlled Substance Handling

At your institution, consider implementing ISMP Hierarchy of Error-Reduction Strategies when designing safeguards and systems to prevent drug diversion. Implement barriers and fail-safes as opposed to low-leverage strategies such as rules and policies. 

#4 Report and Respond to Potential Diversion

Organizations should create a standardized anonymous reporting system for staff to report concerns for drug diversion. Encourage reporting and remind staff about how vital it is for the health and safety of patients and diverters as well as legal and regulatory reasons. Reassure staff their reports will be confidential and there will be no retaliation for those who report.

#5 Patient Involvement 

Patient education and involvement is paramount and beneficial when it comes to combatting drug diversion. Patients receiving controlled substances should be educated on how to identify signs and risk of addiction. Additionally, patients should be educated on how to safeguard their controlled substances at home and should be provided with resources to help them do so. During prescription pick-up, encourage patients to check their medication and verify the amount dispensed.