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Tuesday, March 15, 2022 12:00 PM

The Continued Prevalence of Drug Diversion in Healthcare

Written by Carolyn Bourke, RN, BSN, Product Owner — DetectRx - iatricSystems

drug diversion in hospital


Drug diversion has continued to be a major problem in healthcare, one that has considerable consequences. Since the onset of the COVID-19 pandemic, the problem has continued to become more and more prevalent.

Approximately 10 to 15% of all healthcare professionals will misuse drugs or alcohol at some time during their career.1 Even more worrisome is that an estimated 95% of drug diversion cases remain uninvestigated. This is unfortunately due to organizational denial and ineffective monitoring.2

An estimated 80 to 93% of these diversions are still going undetected. The failure to detect drug diversion as it occurs is defined as a false negative. These incidences are more common than you may think. For example, national estimates for a mid-size, 500-bed hospital, suggest that around 25 to 75 individuals are at risk for diverting drugs at any time. In the meantime, roughly only 65% of hospitals in the survey investigated five or fewer cases each year.3

This is a widespread issue that we see happening in many of our local communities. A recent incident was reported in Northeast Florida, where a local ICU nurse was found to be diluting fentanyl doses meant for patients in need. After laboratory tests and further investigation, it was found that the nurse had been diluting the doses with saline.4

Impacts and Mitigation

When drug diversion incidences are left uninvestigated, there can be significant impacts on the organization, both financially and in terms of patient safety. There are multiple facets to the safety impacts of drug diversion.

First and foremost, as the biggest concern, drug diversion impacts patient safety in the following ways:

  • Inadequate pain or anesthesia control
  • Potential risk for infection
  • Unsafe care by an impaired provider

There are also the obvious risks to the diverting employee’s health in the form of deepening addiction and an escalation in that type of behavior. This ultimately puts the employee’s health and career at risk.

Finally, there are public safety risks, including: 

  • Potential for DUI, as employees that divert and consume controlled substances near the end of their shift
  • Potential to sell drugs to the public from those who divert drugs 
A healthcare organization can also see financial impacts when one of its employees has been diverting drugs while on duty. These impacts can include:
  • Damage to the organization's reputation due to the publication of the drug diversion
  • Damage to employee morale 
  • Monetary losses as a result of:
    • Inventory loss
    • Loss of productivity
    • Lawsuit related expenses and settlements related to patient injury
    • Regulatory audits and potential fines
    • Costs associated with investigating and treating those conditions that result from drug diversion, such as addiction and infection
There are ways to mitigate the risks of drug diversion in your organization. By providing staff with proper education about diversion, including covering the various scenarios of how drugs are diverting, your staff can help identify and report potential diversion. Your hospital will then be able to conduct routine risk surveillance rounds and identify areas for improvement.

Aside from general education, the best way to mitigate diversion risks is to establish a drug diversion monitoring program. With a monitoring program, your organization will be able to utilize tools that can help the hospital detect the diversion and begin an investigation into the matter as soon as possible, without relying on your staff to take on this burden.

What’s Next

With the prevalence of drug diversion still being a problem in hospitals, having ways to mitigate your risks can go a long way. You can contact us at if you’d like to learn more about any of our clinical/EHR solutions that can help support you with detecting drug diversion – whether it is finding discrepancies with your hospital’s dispensing cabinet records or opening a prompt investigation into possible diversion.