Drug diversion is defined as the use of prescription drugs for recreational purposes - "diverting" of legally obtainable drugs into illegal channels, or the acquiring or obtaining of a controlled substance by an illegal method. If charged and convicted of such, it comes with a fine from $1,000 to $250,000 and a prison term of one to twenty years. The Drug Enforcement Agency (DEA) has been known to arrest patients, general staff and licensed professionals.

Diversion occurs in all levels of controlled distribution including: manufacturers, distributors, pharmacies, hospitals, ambulances, physician offices, etc. Methods of diversion include theft, which is often accompanied by record falsification, requesting a script to be filled or obtained for someone other than the person it was written for, and giving your prescription medication to someone else.

Healthcare facilities should have adequate policies and procedures in place to prevent diversion of controlled substances which would encompass:

• Drug diversion prevention
• Record keeping requirements
• Controlled substance loss reporting
• Medication security requirements
• Regulations for practitioners
• Pharmacy dispensing procedures
• Drug destruction, wasting, and disposal processes

The Centers for Medicare and Medicaid (CMS) and DEA have the authority to inspect the record-keeping and security of any facility registrant or applicant for registration. Frequently, CMS and DEA will conduct inspections in conjunction with state regulatory agencies.

Scope of practice issues are also within the authority of the DEA. All allegations related to questionable prescribing, solicitation of prescriptive medication, diversion and dispensing patterns, should be referred to the appropriate licensing boards and authorities. Facilities should also routinely review the practices of their employees to guarantee compliance. The pharmacy department is responsible for all activities concerning controlled substances within that facility. When violations of controlled substance requirements are identified in facilities, administrative action may result against the facility as well as individual practitioner registrants depending upon the situation. Reporting of drug diversion by fellow employees is not only a necessary part of an overall employee security program but also serves the public interest at large.  It is, therefore, the position of the DEA that an employee who has knowledge of drug diversion by a fellow employee has an obligation to report such information to a responsible security official of the employer. Methods to detect/prevent diversion include:

• Comply with record-keeping and security requirements
• Physical counts
• Observation for tampering
• Visual Monitoring and auditing
• Observation for impairment

Resources:

21 CFR 1301.91  

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