Survey Finds Perception Among Challenges in Combating Drug Diversion in Hospitals

A national survey examining drug diversion in United States hospitals has found many executives and care providers, including pharmacists, are concerned about possible drug diversion in facilities across the country, but few think that there is cause for concern at their own workplaces.¹

Commissioned by medical technology company Becton, Dickinson and Company (BD), the survey also found that half the 651 respondents said they had observed suspicious activity in their hospitals that may have been evidence of drug diversion.¹

The independent survey, conducted by KRC Research for the BD Institute for Medication Management Excellence, collected opinions between February 20 and 28, 2019.

Respondents included anesthesiologists, a diverse group of nurses, hospital diversion managers, hospital executives, pharmacists, and pharmacy technicians, according to BD.¹

Results of the survey were published in the report Health Care’s Hidden Epidemic: A Call to Action on Hospital Drug Diversion.¹

Overall, 85% of those surveyed said that they were concerned about drug diversion in the United States, while 20% said that there is a concern in their own hospitals.¹

Among pharmacists included in the survey, 99% said that substance use disorder is a significant problem in the United States, with 59% saying that substance use disorder is a significant problem in US hospitals, while 16% said that they think that substance use disorder is a problem in their own hospitals.²

“Hospital drug diversion is a problem that is difficult to detect and impacts patient and provider safety,” David Chen, senior director for the American Society of Health-System Pharmacists Section of Pharmacy Practice Managers, said in a statement.³

“Health-system pharmacists play a critical role in preventing substance abuse and the diversion of drugs in the health care setting," he said. "They educate health professionals and the public and assist with evaluation and treatment of patients, co-workers, and others who have issues with substance abuse.”

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The survey also found that overall respondents think that hospitals are stressful environments, which may lead to substance misuse among health care providers, and 78% of providers surveyed have known a peer who seemed stressed “to the breaking point."¹

Providers cited emotional demands, long hours, patient volume, and staff shortages as primary reasons for stress in a hospital.²

Nearly 200 people a day on average die from opioid overdose, according to a 2019 analysis by the National Safety Council.

Between 10% and 15% of the general population will misuse substances in their lives, including health care workers with access to controlled substances.

This creates a vulnerability beyond that of the general population, making diversion a very serious problem across hospitals and health systems, according to BD.¹

Eighty percent of executives and 60% of providers surveyed said that diversion is very difficult somewhat difficult to detect.

However, 92% of executives and 90% of providers said they think that diversion detection tools used by their hospitals are somewhat or very effective.

The majority of respondents (63% of executives and 59% of providers) expressed confidence that their hospitals are investing the appropriate resources to fight diversion.²

“This report clearly shows how difficult the issue of drug diversion is to detect, as well as the challenges hospitals and health systems face with tracking and managing cases of diversion within their own facilities,” Perry Flowers, vice president of medical affairs at BD, said in a statement.¹

“Diversion is not a new problem in health care, but recent advancements in diversion tracking include machine learning to intelligently analyze opioid transactions and reduce false positives" he said. "Establishing a culture of open dialogue and reporting that encourages recovery may also be key to efforts that address diversion.”

The survey demonstrates the importance of establishing systems for preventing controlled substance diversion or opioid stewardship programs that expand current efforts to treat staff and patients in need of assistance, according to Chen, who also noted that the ASHP offers detailed guidelines for diversion prevention around certain risk points.³

"Pharmacists have the skills to help establish protocols for preventing diversion," he said.³ "Common risk points for diversion occur during medication procurement, preparation and dispensing, prescribing, administration, and waste removal."

The overall goal of the drug diversion survey report is to foster a national conversation on the best ways to address this drug diversion. Left undetected, diversion can lead to harm to the diverter, patient safety issues, and significant risk for the organization.¹

“This report is an opportunity to encourage more robust discussion about diversion and how we can prevent it, detect it and help the hospital employees who are affected by it,” Ranjeet Banerjee, worldwide president of medication management solutions at BD, in a statement.¹ “While there won’t be a one-size-fits-all solution, we believe this report should spur additional research and ultimately lead to more actionable programs and resources for hospitals to adopt solutions.”

The survey report includes additional data and personal insights that highlight barriers and solutions and bring context to the raw data. A resource guide within the report focuses more narrowly on ways to support hospitals as they address this problem, such as implementing machine learning and other technologies, and improving diversion education and training.¹

References

• New report sheds light on health care's 'hidden' epidemic—hospital drug diversion—and its role in the opioid crisis [news release]. Franklin Lakes, NJ; June 4, 2019. BD. [email] Accessed June 5, 2019.
• BD. Health care’s hidden epidemic a call to action on hospital drug diversion. www.go.bd.com/rs/565-YXD-236/images/MMS_BD-Institute_Diversion_RP_EN_Report.pdf. Published June 4, 2019. Accessed June 5, 2019.
• American Society of Health-System Pharmacists. ASHP statement: how to prevent drug diversion in Health systems. ASHP. [email]. Created June 5, 2019. Accessed June 5, 2019.