By Tom Knight, Chairman of the Healthcare Diversion Network
In 2009, nearly two dozen patients at Rose Medical Center in Boulder, Colo., were infected with Hepatitis C after a hospital worker with the disease diverted their injectable medications, swapping clean syringes for tainted ones.
The incident, which culminated in a prison sentence of 30 years for hospital technician Kristen Parker, was a wakeup call for healthcare leaders and policymakers. Since 2009, we’ve seen a massive rollout of guidelines, toolkits and proposed legislation intended to combat drug diversion.
Yet as the broader opioid crisis rages on, incidents of drug diversion in healthcare facilities— whereupon medication is inappropriately deterred from its intended destination — have only increased in frequency. As shown in this table, drug diversion by healthcare workers has caused large outbreaks of viral and bacterial pathogens that have harmed large numbers of patients.
“Over the years, we’ve seen dozens of cases of infections associated with drug diversion including HCV and bacterial bloodstream infections. These outbreaks are evidence that there are gaps in efforts to prevent and detect drug diversion in healthcare facilities across the country. We need to implement stronger measures to monitor and detect drug diversion activities,” said Matthew Crist, a medical officer for the Centers for Disease Control and Prevention (CDC) and a member of the advisory board for the nonprofit Healthcare Diversion Network.
The consequences of drug diversion aren’t limited to exposing patients to life-threatening illnesses. There are also legal, financial and emotional consequences for multiple stakeholders, from healthcare workers and patients themselves, to their loved ones and community.
But while we’ve made strides as a nation in raising awareness and implementing training at healthcare facilities, adopting regulations and policies, evidence suggests we could be doing more.
Today healthcare leaders have access to a wider range of smarter, more sophisticated communications technology solutions that can help fight drug diversion at all levels. We need to do a better job of utilizing these technologies that not only alert us when medication is missing but help us gather and leverage data for prevention and expand our knowledge base.
Understanding the Scope of Drug Diversion
As we explore new approaches to drug diversion and technologies, it helps to consider both the scope of the problem in healthcare settings and the approaches healthcare leaders have taken to address it thus far.
In a recent study of healthcare workers conducted by Porter Research and sponsored by Invistics, 86 percent said they have met or known someone who has diverted drugs.
In 2018 alone, the Department of Justice made more than 50 enforcement and more than 280 administrative actions related to drug diversion. In the largest case of healthcare fraud enforcement that year, the U.S. Department of Justice (DOJ) and the U.S. Drug Enforcement Administration (DEA) charged 165 doctors, nurses and other providers for their participation in a $2 billion fraud scheme, which included their role in prescribing and distributing opioids and other dangerous narcotics.
And while we’re implementing standalone solutions, such as additional training of staff to recognize signs of drug abuse, there are other tools we can begin to implement. The recent Porter Research survey indicated that only 13 percent are very confident that the drug diversion program at their facility successfully identifies employees that divert drugs.
We’re also up against a culture in healthcare settings where healthcare workers may be reluctant to speak up due to the negative stigma attached to drug diversion, and it’s difficult for a facility to come to the realization that they have a problem that warrants tougher actions. Meanwhile, individuals who divert drugs are becoming more adept in their ability to circumvent detection.
Putting Smarter Tools and Data to Work
Technology can — and does — support efforts to combat drug diversion and thwart potential diversion earlier in the lifecycle of patient care.
For example, the Drug Supply Chain Security Act (DSCSA) provides new safeguards for tracking medications across the supply chain.
However, to truly effect change, we need solutions that go beyond one-time alerts for incidents that may or may not warrant investigation. Advanced machine-learning technologies, which are fueled by algorithms that can collect and analyze data to isolate trends that are correlated with diversion, are new methods that should be considered to aid in the early detection of diversion in healthcare settings.
Understandably, most hospitals are only beginning to see the role these advanced technologies could play in reducing diversion. Over time, we hope that healthcare organizations will take the issue seriously and tap into every tool at their disposal to prevent incidents like the 2009 Hepatitis C outbreak at Rose from ever happening again.