Substance Use Disorders and Drug Diversion : What Nursing Students Need to Know
By Georgia Reiner and Cindy Saver
Drug diversion occurs when healthcare clinicians divert a drug intended for a patient for their own purposes . Clinicians may steal drugs to sell or to use themselves because they are suffering from substance use disorder ( SUD ).
Nursing students should be aware that , as clinicians , nurses aren ’ t immune to SUD or drug diversion . According to the Diversion Digest Report from Protenus ( 2021 ), a healthcare compliance analytics platform , statistics from the U . S . Substance Abuse and Mental Health Services Administration and the American Nurses Association suggest that about 10 % of healthcare workers abuse drugs . Further , the 2021 Diversion Digest Report found that nurses were responsible for 31 % of publicly reported drug diversion incidents in 2020 . Both SUD and drug diversion have significant professional implications that nursing students need to understand as they begin their nursing careers .
SUD and Drug Diversion Unfortunately , incidences of SUD and drug diversion have risen in recent years . Further , drug diversion is likely underreported because a significant number of diverters go undetected despite warning signs . The Diversion Digest Report notes that the COVID-19 pandemic has likely contributed to underreporting .
According to the Drug Enforcement Administration ( DEA ), the most common classes of drug that are abused are opioids , depressants , hallucinogens , stimulants , and anabolic steroids . Opioids are the most common class of diverted drugs , with oxycodone , fentanyl , and hydrocodone leading the way ( Protenus , 2021 ).
Methods for diverting drugs include obtaining drugs by not “ wasting ” them in situations where they would normally be disposed of ( for example , drawing up too much medication ), not administering drugs to patients , and administering a substitute substance such as water or saline ( Perry , 2019 ).
Consequences of SUD and Drug Diversion The consequences of drug diversion are many , including criminal and civil legal action against the diverter . Not only can nurses , nursing students , and other healthcare providers be charged with a felony , but they can be sued by patients who experience inadequate pain relief or infection as a result of tampering . According to the Centers for Disease Control and Prevention ( 2019 ), when clinicians with hepatitis C virus or another bloodborne infection tampered with an injectable drug , they contaminated equipment , resulting in subsequent infection . In addition , nurses with a SUD may make errors that cause patient harm and subsequent legal action . And , of course , these nurses experience significant physical and psychological harm to themselves .
Drug diversion and suboptimal practice due to SUD also can prompt nurses , other healthcare colleagues , or patients to file reports with the state board of nursing that can result in loss of license — and a career — even for nursing students .
SUD and drug diversion also violate multiple provisions in the Code of Ethics for Nurses with Interpretive Statements ( American Nurses Association , 2015 ). For example , provision 2 states “ the nurse ’ s primary commitment is to the patient …” Drug diversion puts the nurse ’ s interests over the patient ’ s . Provision 3 requires nurses to promote , advocate for , and protect the rights , health , and safety ( emphasis added ) of the patient . Finally , provision 5 states the nurse “ owes the same duties to self as to others , including the responsibility to promote health and safety , preserve wholeness of character and integrity …” SUD does not promote self-care , and those who divert drugs do not act with integrity .
Identifying and Reporting Review the sidebar titled Signs of Drug Diversion . To protect patients , nurses and nursing students who suspect diversion ) should report their suspicion to the supervisor or preceptor ; the organization then has the responsibility to investigate the claim . If action is not taken , the Healthcare Diversion Network ( N . D ) suggests reporting the incident on its website or filing a report with the state board of nursing . In the case of theft of controlled substances , the DEA Form 106 can be submitted ; the form is available at : www . deadiversion . usdoj . gov / Reporting . html .
Preventing Drug Diversion As you embark on your nursing career , keep in mind the following strategies which can help reduce the risk of drug diversion :
• Use controlled substances in dose sizes that minimize waste .
• Avoid range orders for controlled substances because they promote waste .
• Only remove controlled substances from automated dispensing cabinets right before they are to be administered .
• Waste immediately ; delays can increase the risk of diversion .
• Know your organization ’ s wasting policies .
• Understand the symptoms of substance use disorder and what to do when you see it .
• Dispose of drugs safely per EPA requirements .
• Speak up when you suspect diversion .
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