Drug Diversion in Vermont

The Medicaid Fraud Unit of theVermont Attorney General'sOffice recently got into the moviebusiness. No, it is not something made inHollywood, but it is a movie about a veryserious problem that has been presentacross the United States for manydecades. That problem is the diversion ofmedications by health care workers whoare addicted to the medications andsteal the drugs from their patients.

Reportedly, the documentary features4 former addicts, all health care workers,who have cooperated with the VermontAttorney General's Office in telling theirstories, in exchange for more lenient sentences.

In my many years of experience indrug diversion offenses, health facilitycrimes make me realize the grip that prescriptiondrug addiction can have on aperson. Highly trained, compassionatehealth care employees, who certainly didnot go to college so they could abusepharmaceuticals, become individualswho can be impaired while in a job thatmay very well require them to make lifeand-death decisions for their patients.

The ultimate crime, however, is that ofsubstitution—removing controlled substancesfrom their package or syringeand replacing them with saline or a substitutetablet, and being apparently obliviousto the level of pain that will undoubtedlybe incurred by the innocent patientwho receives this tampered product.

When I retired from the CincinnatiPolice Department's PharmaceuticalDiversion Squad, my investigators werearresting a health professional aboutevery 6 days; most of those were nursesworking in health facilities. Approximately10% of those arrested were engaged insubstitution when they were finallycaught. This is not to say that nurses arebad people; they just are the largest numberof licensed health professionals in anystate, and they have a great exposure tocontrolled substances.

On the positive side of this story,approximately 60% of those we caughteventually successfully completed rehabilitation.That is a high number whencompared with the general public's rateof success, and many of these went onto continue in some form of employmentin the health care industry.

One of the major stumbling blocks toaddressing this problem has been thereluctance of many health facilities toreport these crimes and do somethingbesides fire the workers, sending themon to the next facility with no cure fortheir addiction.

Perhaps, if strict sanctions were imposedon health facilities whose officalsfail to report internal drug diversion, thenthese businesses would get seriousabout reporting this crime.

The Vermont Attorney General's Officeshould be applauded for its efforts indirectly trying to deal with this problemthrough awareness and education. Toomany health facilities have kept this asecret for too long, causing needlesspain and suffering in patients and tragedyfor addicted health professionals, whoare not given a choice between rehabilitationand possible incarceration.

Some of our best resources to investigatehealth facility diversion came fromthe hospital pharmacy or the pharmacysupplying drugs to the nursing home.Oftentimes, the pharmacist reporting theincident was the key to patient safetyand the salvaging of a health care worker'scareer—or life. I urge you to keepthat in mind when coming face-to-facewith an obvious diversion in a healthfacility. You may very well be the differencebetween a successful outcome anda tragedy.

John Burke, commander ofthe Warren County, Ohio,drug task force and retiredcommander of the CincinnatiPolice PharmaceuticalDiversion Squad, isa 38-year veteran of lawenforcement. Cmdr Burkealso is the current presidentof the National Association of Drug DiversionInvestigators. For information, he can bereached by e-mail at burke@choice.net, viathe Web site www.rxdiversion.com, or byphone at 513-336-0070.