Drug Diversion – The Ever-Present Security Threat

This week I am taking a moment to spotlight drug diversion in healthcare. Drug diversion is a growing security threat and has only been exacerbated by the opioid epidemic. For this, I am sharing a question and answer session with Mike York, The Drug Diversion Specialist for Piedmont Healthcare. Mike is a wealth of knowledge and is a rising leader in the national discussion on drug diversion. You can check him out on LinkedIn. Below is our discussion:

Hodges: Mike, put simply, what is drug diversion?

York: “The simplicity of the answer depends on the intended audience.  I will often say, “Drug diversion is theft.”  While this is true, it makes the issue seem completely inventory related.  This would be a quick and easy response if justification is needed for filing a local police report. However, to be complete, I would say drug diversion occurs when a medication’s intended destination is altered.  You will often see definitions online that include “legally prescribed” or “controlled”.  However, since drug diversion can occur during the procurement process and with uncontrolled meds, I choose to leave those additional descriptors out. That turned out to not be a very simple answer.”

Hodges: Can you explain the threat drug diversion poses to healthcare organizations?

York: “I believe the threat is so vast that you could publish a paper solely on this question.  I like to think of the organizational threat in three broad categories: patient, employee, and the business itself.

Patients are affected when they do not receive the proper quantity or type of medication that was prescribed.  They can be hurt when they are receiving treatment from someone under the influence.  There are several documented cases of nurses injecting themselves with the same needle they intended to use on the patient.

Employees, whether they are the diverters or not, can be affected as well.  The diverting employee can suffer substantial harm from using medications not intended for them.  Overdosing while on the job is a real concern.  The non-diverting employee is also at risk because they are working alongside of someone who is under the influence.

The business has to comply with DEA / state laws and regulations.  The government can levy exorbitant fines for non-compliance.  Additionally, the patients and employees that received harm could sue the organization.  The damage to the organization’s brand may have the highest financial impact.”

Hodges: How is Drug Diversion a security risk, is this more than just loss prevention?

York: “Loss prevention is likely the most commonly associated security risk.  However, I believe there are other things to consider. As a former law enforcement officer, I have always thought hospitals should have a heightened security posture due to the access of controlled medications.  Criminals would much rather rob a convenience store than make an attempt on a bank.  Banks are typically a hardened target due to their security measures.

Also, robbery is a considered a persons crime not a property crime.  When banks are robbed, the money isn’t the immediate concern, its the people inside.  Hospitals have to recognize that they are the banks for controlled medications.”

Hodges: What are some key means to mitigate the risk?

York: “There is an interesting stat floating around that says 1 in 10 nurses will attempt to divert at some point in their career.  There is another one that says at least 10% (or more) of all nurses are addicted to something.  Before we go on, it is important to note that these stats could be applied to any population and be somewhat accurate.  It isn’t a slight on nurses.

That being said, the most efficient way to keep the 10% in check is to use the other 90%.  Educating all staff, clinical or not, on the risks and signs of drug diversion is paramount.  Security cameras are great, but they are nowhere near as effective as many pairs of eyes along with a healthy dose of scrutiny.

That doesn’t mean cameras are ineffective.  Next to a well-designed education program, I would rank cameras fairly high on the mitigation ladder.  At a minimum, there should be camera coverage on all entrance/exit points and all dispensing locations (i.e. dispensing cabinets, pharmacy windows, etc.).

The last mitigation point would be to acquire some form of analytical software.  Hospitals will want something that is vendor agnostic and capable of comparing dispenses, wastes, and returns to the electronic medical record.  While it is certainly possible to find problems with a manual process, it is incredibly time consuming and inefficient.”

Hodges: How should healthcare security leaders be engaging with this issue?

York: “The first step to addressing any problem is to first acknowledge that the problem exists.  If security leaders are not considering drug diversion a security threat, they need to.  I imagine the lack of acceptance is more likely to occur with senior hospital officials.  If this is the case, security leadership will have to get them onboard.  This may be the quintessential example of an uphill battle, but it must be fought.  Hopefully, the security leadership has already built a rapport with the hospital leadership to help facilitate such battle.

Hodges: What is one thing about drug diversion you think everyone should know?

York: “The one thing everyone should know: drug diversion is happening at your facility. Once we all get that through our heads, everything else is manageable.”

I want to thank Mike for his time, and for sharing his expertise with our community. How does your facility tackle the issue of Drug Diversion?  Do you have a Mike York leading the charge? How does your security department fit into that equation? Join the conversation in the comments below. Also, please like, follow and share to support the Proactive Security Blog.

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