Diversion of Controlled Drugs in Hospitals: A Scoping Review of Contributors and Safeguards

Abstract

T he United States (US) and Canada are the two highest per-capita consumers of opioids in the world; 1 both are struggling with unprecedented opioid-related mortality. 2,3 The nonmedical use of opioids is facilitated by diversion and defined as the transfer of drugs from lawful to unlawful channels of use 4,5 (eg, sharing legitimate prescriptions with family and friends 6). Opioids and other controlled drugs are also diverted from healthcare facilities; 4,5,7,8 Canadian data suggest these incidents may be increasing (controlled-drug loss reports have doubled each year since 2015 9). The diversion of controlled drugs from hospitals affects patients, healthcare workers (HCWs), hospitals, and the public. Patients suffer insufficient analgesia or anesthesia, experience substandard care from impaired HCWs, and are at risk of infections from compromised syringes. 4,10,11 HCWs that divert are at risk of overdose and death; they also face regulatory censure, criminal prosecution, and civil malpractice suits. 12,13 Hospitals bear the cost of diverted drugs, 14,15 internal investigations, 4 and follow-up care for affected patients, 4,13 and can be fined in

Methods for Research Evidence Synthesis: The Scoping Review Approach

“…Fan et al used the scoping review approach to examine the available information on contributors to and safeguards against controlled-drug losses and theft (drug diversion) in the hospital setting. 3 The authors addressed the following questions: (1) "What clinical units, health professions, or stages of the medication-use process are commonly discussed?" (2) "What are the identified contributors to diversion in hospitals?"…”

“…1 In this issue of the Journal of Hospital Medicine, Fan et al used a scoping review to identify information available in the literature on contributors to loss and theft of controlled drugs in hospitals and the safeguards that have been suggested to address these diversions. 3 The authors followed Arksey and O'Malley's framework for scoping reviews and the PRIS-MA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist in reporting findings. 2,4…”

Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk

“…17 In many cases, propofol is not inventoried, routinely counted, or locked up. 3,7,11 These inadequate safeguards in pharmacy systems increase the risk for diversion. Horvath 4 described a unit's implementation of a new drug inventory policy and discovered 104 425 mg of propofol unaccounted for over a 4-week period during the project.…”

“…2,[7][8][9] Health care professionals are the primary agents of diversion because of the accessibility of propofol and their clinical knowledge about the drug. 2,4,[8][9][10][11][12][13] Staff members in anesthesia-related clinical areas are at highest risk because of their direct access to propofol in the workplace. 9,10 Published articles about propofol have discussed the lack of DEA regulation and the relative ease of access.…”

“…9,10 Published articles about propofol have discussed the lack of DEA regulation and the relative ease of access. 4,[7][8][9]11,12 In addition, propofol's effects are shortlived, enabling users to assimilate back into their routine, largely unnoticed, after using propofol. 10 The dose to achieve a pleasurable effect is small, so low volumes of diverted drug are clinically significant.…”