Drug Diversion Occurs Worldwide

There have been increasing numbers of reported cases of drug diversion by healthcare personnel across the globe in the recent past. Here in the US, we struggle to help leaders in our facilities understand the scope of the problem. The articles referenced below would tend to suggest that healthcare facilities in other countries are also dealing with diversion by staff, and are many times trying to make administrators aware of the risks and the frequency with which diversion happens.

In addition to the article from Mumbai below, just a few cases we have seen reported recently include:

Report from Mumbai

Arrest of nurse carrying smuggled drugs brings medical industry under scanner

The article from Mumbai further lends support to the premise that the problem of diversion by healthcare personnel extends well beyond US borders. The author of the article describes drug diversion by healthcare personnel as a “dark secret” in the healthcare industry in India. The reported case involves an ICU nurse who was diverting a fentanyl combination. The article sites the opinion of one physician that the diversion scheme was most likely motivated by a need for personal use.

As we have seen in previous cases outside the US, the propensity to divert in Mumbai and elsewhere in India is attributed to a lot of the same factors that we see here. These include a stressful work environment, injuries, and a desire to self-medicate. The article refers to cases of physicians diverting and struggling with addiction, and alludes to more than one case in which a diverting staff member overdosed and died.

Also akin to cases in the US, the article describes nurses preying on vulnerable patients who can’t speak for themselves. It describes withholding pain medication or administering a partial dose, and it states that nurses involved in this type of activity commonly falsify records.

Interestingly, some suggested solutions include blood testing of high risk staff, allowing relatives to supervise injections, and rotating staff so they don’t have ongoing access to the same strong opioids. The article alludes to drug screening patients as well. Some of these measures might be helpful, but diverting staff are likely to be able get around most of these controls.

The FDA in India is the regulatory entity at least partially in charge of supervising the use of the drugs discussed in this case. An FDA representative stated, “Doctors and hospital staff are custodians of controlled medicines needed for treatment of patients, and if they start misusing such drugs themselves, it is a serious issue and in violation of existing norms. The FDA’s role is to ensure that patients do not suffer because of lack of medicines and, if these drugs are misused, the hospital administrations should take corrective measures.” A physician who was interviewed for this article stated, “The rampant misuse of medicines has been ongoing since the early 1990s, but the hospital administration has done little to curb it.”

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