Since early 2020, the opioid epidemic has gone into overdrive. In the first six months of 2021 alone, an estimated 53,000 people died of opioid overdoses.
But not enough has been done to address the parallel rise in drug theft among clinicians in healthcare settings, also known as healthcare drug diversion. In fact, during the pandemic, many healthcare organizations have been scaling back resources that address the theft of prescription medications by their staff.
What healthcare organizations really should be doing is doubling their resources, so they can ensure the right people, technology and processes are in place to support a strong, secure medication supply chain.
Drug diversion occurs frequently
The statistics are hard to ignore. More than 80% of healthcare executives polled for the 2021 Porter Research and Invistics survey on diversion have met at least one healthcare worker who has diverted drugs, and 73% agreed that most drug diversion goes undetected.
That’s because drug diversion takes many forms: people who divert drugs are always trying to game the system to avoid getting caught. The phenomenon of “job shopping” among clinicians who seek new employment after a supervisor accuses them of suspected diversion inspired the passage of the Cullen Law in New Jersey.
In June 2021, Missouri became the 50th state to implement a statewide Prescription Drug Monitoring Program (PDMP) in an effort to curb “doctor shopping” and prescription opioid abuse. Under the new legislation, SB 63, healthcare professionals will be able to monitor the dispensation of prescribed drugs and avoid duplicate prescriptions for patients who are seeking drugs from multiple providers.
So how do medications slip into the wrong hands when health systems are scrutinized and heavily regulated by the DEA, state licensing boards, and other governing bodies?
What it usually comes down to is a lack of resources. In 2020, due the challenges from the COVID pandemic, most healthcare organizations scaled back resources for preventing drug diversion. During that year, 45% of healthcare organizations reported having one or more full-time, dedicated drug diversion employees, compared with 58% in 2019.
Amplifying these challenges is the fact that the subject of diverting is still frequently stigmatized. Few, if any, healthcare organizations want to admit that drug misuse and/or diversion is a problem. Understandably, healthcare leaders are concerned with the perception of their facilities by potential patients, families and new hires.
Strengthening defenses against drug diversion
Preventing drug diversion starts with an opioid stewardship plan that is comprehensive and inclusive.
Healthcare facilities need clear guidelines for acute pain management, harm reduction identification, treatment of opioid use disorder and handling drug diversion. These guidelines should be paired with staff education and training pertaining to drug misuse by patients and staff.
Technology is another consideration. As researchers have noted, official PDMPs “often do not detect doctor shoppers who cross state borders.” So, if a patient from Washington visits a healthcare facility in Portland, Oregon, three days later, that Oregon hospital isn’t necessarily flagged to the pattern of frequent visits.
One way to speed up detection healthcare drug diversion is to leverage analytics and machine technologies, which can process multiple data streams (clinical data, police records, patient pain reports) and dispatch alerts in a shorter timeframe. In a recent retrospective study, “Detecting Drug Diversion in Health System Data using Machine Learning and Advanced Analytics,” researchers showed that data analytics and machine learning technologies detected known diversion cases an average of 160 days faster than existing, non-machine learning detection methods. Additionally, the machine learning model demonstrated 96.3% accuracy.
Given that time is of the essence when it comes to discovering diversion — and redirecting patients and healthcare providers to seek help, when necessary — use of these technologies could save thousands of lives.
Methods of reporting suspected diversion should be transparent, and if workers feel uncomfortable reporting something to their employer, they should be directed to submit tips anonymously.
Given the millions of dollars at stake for hospitals stemming from potential lawsuits, legal fees and noncompliance fines for not doing enough to end the opioid epidemic, hospitals can no longer delay. It’s time to strengthen medication supply chains by arming healthcare staff with the tools and technologies they need to stop drug diversion before it’s too late.