Fundamental Drug Diversion Course

This one hour represents a summary of 25 years of law enforcement work in the field of drug diversion inside healthcare facilities. This was gained while I was the Commander of the Cincinnati Police Department’s Pharmaceutical Diversion Unit, where we detained on the average of one health professional per week involved in diverting medications from hospitals and nursing homes. 

The presentation will explore the basic profile of a diverter along with methods of detection, interviewing and interrogation. In addition to diversion prevalent on each floor, a special look at the Operating Room will also be analyzed. Discussion will also continue with the aftermath of these detentions, along with attempts for rehabilitation and in some cases, return to the workplace.

The presentation will also dissect one of the most egregious healthcare diversion offenses that entailed multiple health facilities across the United States. Information on how this subject was finally caught after infecting dozens of patients nationwide with a bloodborne pathogen. This case, and others, will spotlight the importance of each institution properly reporting these drug diversion offenses and the unfortunate consequences when laws and regulations are illegally bypassed.

This session will cover multiple components and processes necessary to be included in a comprehensive healthcare drug diversion monitoring program. The course will cover recommendations around positions to carry out the program work, committee structure, and response team makeup. Policies/procedures, risk assessments, security considerations for controlled substances, and analytical tools will be reviewed as important components of a drug diversion prevention and monitoring program.

Course instructors will also talk in depth about monitoring, surveillance, investigations, and reporting. Finally, the need for creating a culture of safety which includes education will be reviewed. The course will provide applicable tools and resources along with interactive real life case studies and opportunities for discussion and asking questions.

Healthcare facility drug diversion programs across the United States are increasing in sophistication in step with increasing rates of opioid use disorder generally, including among healthcare workers (HCW). Persons who inject drugs (PWID) are themselves at very high risk for infection with bloodborne pathogens (BBP) including hepatitis C, HIV, and hepatitis B, particularly if they share injection equipment with others. Since these infections are often asymptomatic, an infected healthcare worker may be unaware of their status. A HCW who is infected with a BBP and engaging in drug diversion of injectable products using tampering and substitution methods is at high risk of infecting patients who receive contaminated medications. Large multi-facility, multi-state hepatitis C outbreaks have been described.

This session will review well described BBP outbreaks caused by diversion with an emphasis on high risk tampering and substitution methods and violations of injection safety best practices. The case will be made to add for-cause BPP testing at the time of intervention or termination to inform other response activities. A Centers for Disease Control and Prevention assessment approach to determine the need for patient notification and BBP testing will be described. Additional recommendations and resources will be shared.

The intent of this presentation is to focus on what we believe is the most critical component of the investigation process: The Interview. The interview is all too often overlooked, misunderstood, and mishandled by well-intentioned leaders who may not be fully prepared to perform this responsibility at the level needed. There are inherent obstacles when trying to determine the truth under very stressful circumstances.

Drug diversion interviews are by their very nature high-stress with much at stake. To overcome these challenges, the interviewer needs to possess a significant level of training and experience. The latter poses its own set of challenges when the interviewer is unaccustomed to utilizing conversation on a daily basis to determine the truth. To help better understand the importance of a sound interview approach, it is helpful to possess a general awareness of drug diversion nuances in healthcare.

In 2009, Rose Medical Center in Denver Colorado experienced an outbreak of Hepatitis C (HCV) which infected 19 patients. A CDC investigation occurred after two patients tested positive for HCV having procedures two days apart at the same facility. This incident led to the arrest of a surgical technician who had been diverting syringes of fentanyl for her personal use. This presentation will explore the events leading up to the outbreak as well as highlight how the steps follow a typical pattern of drug diversion cases.

The presenter will give attendees a deeper understanding of drug diversion through the eyes of a harmed patient offering a non-healthcare perspective as well as the lessons learned leading to her role as a patient safety advocate. Attendees will better understand the damage caused not only by an employee’s diversion but from a broken healthcare system.

This presentation will set a framework for the multifaceted scope of the drug diversion problem, who is involved and the cost of non-compliance. An overview of this case helps to outline the multiple red flags which were not heeded resulting in a Hepatitis C outbreak while emphasizing how the role of healthcare workers can be a part of the solution. A summary of needs moving forward will highlight how we can better identify, respond, and handle diversion events more quickly as well as minimize patient harm and encourage recovery for the diverter.

Objectives:

1. Gain an understanding of substance use disorder (SUD) in nursing.

2. Realize the benefits of peer support and learn about the peer support program for nurses in Wisconsin.

3. Decrease the stigma surrounding SUD by listening to one nurse’s recovery journey with an open mind.

The speaker will share her personal journey as a practicing nurse suffering from SUD. She will share her struggle with diversion, SUD, and stigma, as well as her support (lack of peer support), treatment, and recovery. Her story will provide an inspiring, humanistic lens to clinicians working with patients and co-workers suffering from SUD. This presentation aims to raise awareness and reduce the stigma associated with SUD in nurses.