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The Threat of Drug Diversion

March 28, 2018

No controlled substance in a hospital’s pharmacy is completely secure, no matter how many safeguards are in place to limit access to medications, because drug diversion remains a constant threat in health care facilities across the country.

Susan Hayes, principal of Pharmacy Outcomes Specialists in Zurich, Ill., has worked as a private detective for hospital pharmacies to identify drug diverters and prevent the drug stealing from continuing. She recently discussed what pharmacy managers can do to keep a close eye on their medication inventories and staff members, who aren’t immune to the temptations of getting a quick fix or making a quick buck.

Why are pharmacy professionals tempted to divert drugs?

The skyrocketing costs of prescription drugs and the current opioid crisis are major factors. Pharmacy professionals have access to very expensive, very easily transportable drugs. Most of these drugs are in tablet form to make them easier for patients to take, but that also makes them easier for pharmacy workers to steal. They’re using medications to feed their own addictions or sell them on the street.

Michael Levy, a famous researcher at the University of Cardiff in England, tracks prescription drug diversion from the streets of America to terrorist organizations in the Middle East. Terrorists groups are using medications like HIV and hepatitis C drugs to recruit members. They’ll supply the drugs to someone’s family member in exchange for their service in terrorism groups.

What types of drug diversions do you help solve?

I investigated a situation involving a pharmacy tech who was responsible for ordering drugs through a wholesaler, which is a typical arrangement. The wholesaler had provided a single password for the entire pharmacy to use, so there was way to trace who ordered what drug. The tech would order medications on a Tuesday and they would be delivered on a Wednesday, which is when he would stock them. The wholesaler would place drug deliveries on a cart, which was not visible on any overt or covert security camera. The cart also happened to be located next to wall hooks where the pharmacy tech hung his backpack. When medications were delivered, he could slip bottles into this backpack without anyone noticing. So, for example, he would order 5 bottles of Xanax and keep one bottle for himself.

Do hospital pharmacy managers fully appreciate the risk of drug diversion?

No, and there are several potential reasons for that. First, they never assume their employees are capable of diverting medications and often think white collar crimes won’t happen on their watch.

They have an inherent trust in the integrity of their staff members, and that’s not always warranted. The other issue is that hospital pharmacies typically run 24 hours a day and pharmacists who work overnight shifts often aren’t properly supervised.

What are red flags pharmacy directors should look for when trying to s

Drug diverters aren’t always who’d you first suspect. Watch out for the “best employee on the floor.” They're always overly helpful, they never take vacations, and they volunteer for night shifts when no one is watching what they do. They’re the ones who build trust among their managers and often get unsupervised access to controlled medications. Also look for signs of drug abuse. For example, employees who often go out to their cars because they said they forgot their lunch—but that happens multiple times a week—could be using.

What are the most effective ways to prevent drug diversion?

You might be surprised by how many large hospitals don’t have electronic medication inventory systems in place. Pharmacy professionals at those facilities know what medications have been ordered and what medications have been dispensed, and electronic medical records keep track of what medications patients receive, but there’s no virtual inventory at the pharmacy that links those two platforms together. That’s the first piece of advice I’d give: Every pharmacy needs to have a medication inventory management system in place. It doesn’t have to be an expensive software platform—it could be as simple as tracking the medications received from wholesalers, noting what gets dispensed from the pharmacy, extracting medication use data from the EMR, and conducting a simple reconciliation in an Excel spreadsheet each month. Make sure separation of duties are in place with the pharmacy and consider hiring a drug diversion officer, who is expert in pharmacy and security. Pharmacy directors and a hospital’s head of security should meet on a monthly basis to discuss ways to prevent diversion.

Dan Cook

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