While 8% of the general population
suffers with drug dependency, almost
15% of healthcare workers are
dependent on drugs and alcohol.
CMS has identified the following successes in its efforts to
reduce opioid dependency:
• Coverage now includes some form of medication-
assisted treatment across all CMS programs
• 24,000 letters sent in 2017 and 2018 to physicians
identified as prescribing opioids at levels higher than
their peers
• Using data in 2017 and 2018 to identify areas
where Medicare prescribing is higher and merits
more interventions
• Reduction by 40% in 2017 in the number of Medicare
beneficiaries receiving higher than recommended
opioid doses
• Activated 12 Medicaid demonstration tests for improved
opioid use disorder treatment (CMS, 2018)
Another Opioid Problem—Drug Diversion
While 8% of the general population suffers with drug
dependency, almost 15% of healthcare workers are dependent
on drugs and alcohol. This may be due to job stress and easy
access to controlled substances. Drug dependent healthcare
providers may risk patient safety by engaging in unethical
and illegal medication tampering and misuse.
“Many healthcare workers develop and feed their addictions
through drug diversion—the transfer of any legally prescribed,
controlled substance from the individual for whom it was
prescribed to another person for any illicit use—which
threatens patient safety. Often, when healthcare providers
are diverting drugs, such as pain medications, they are
stealing a prescribed medication for a patient and replacing
it with some type of placebo, leaving the patient in pain”
(Montgomery, 2017).
There are cases involving diverters who use syringes on
themselves first and then on patients, with the possibility
of spreading diseases. One diverter is currently serving a
39-year prison sentence for infecting 45 patients through
this deadly practice. A prominent academic medical facility
was recently fined over 2 million dollars for poor practices
that allowed drug diversion to occur (Montgomery, 2017).
Drug Diversion: Solutions
• Health IT can help. Automated dispensing cabinets
(ADCs) can detect diversions in real time. Also, smart
cabinets are able to detect pill miscounts or tampering
linked to an employee’s identification number.
Monitoring every drug transaction is effective against
drug diverters. Some facilities have hired a drug
diversion compliance officer to monitor drug flow
across the hospital (Montgomery, 2017).
• Human factors and training are also important solutions.
Everyone working with controlled drugs in healthcare
must be vigilant, question suspicious activities, and feel
free to act. Leadership must be supportive of staff that
come forward and encourage employees to bring up
potential issues. Empty drug vials in the wrong place
or tampered waste containers should be brought to
the attention of leadership. Senior leadership must let
staff who speak up know the importance of their
contributions to patient safety (Jorgenson, 2016).
• A third solution to the issue of drug diversion relates
to the pharmacy. “It is extremely important that
pharmacies meet this challenge by focusing closer
attention on prescriptions dispensed, ensuring that
hiring policies and staff procedures are sufficient to
detect, discover, and respond to the recent opioid
drug crisis, as well as identify impaired health care
workers and assist them in seeking appropriate
programs for recovery” (Montgomery, 2017).
Opioid Epidemic for the Care Continuum
The hospital is not the only care environment with responsibility
when it comes to dealing with the opioid abuse epidemic.
Here is a sampling of environments outside of acute care and
accommodations they should be making for this problem.
Senior Care (Assisted Living and Long-Term Care)
The senior care industry is not immune to the impact of
opioid abuse. These care environments “experience the
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