Hospitals, health care providers, state government and law enforcement have joined together to create a set of best practices that hospitals and health care facilities can use to enhance security for controlled substances, including narcotics and other powerful prescription medications.
"This coalition has been a great example of government, hospitals and medical professionals working together to proactively address the problem of drug diversions," said Dr. Ed Ehlinger, Minnesota commissioner of health. "We've produced tools that will help protect patients and prevent some of these relatively rare but at times high profile cases involving a health care worker illegally diverting prescription medications."
The coalition, convened by the Minnesota Department of Health and the Minnesota Hospital Association, came together in May 2011 to prevent theft of prescription drugs by health care workers, patients, families, and visitors, and to raise awareness about the issue.
The coalition has created a road map and tool kit that will improve health care providers' controlled substance storage and security, procurement, prescribing, preparation and dispensing. The road map includes training materials, sample policies and procedures, and a flow chart of reporting guidelines and requirements that providers can use when they suspect a drug diversion has occurred.
The road map is a collection of about 100 best practices for preventing and responding to controlled substance diversions. Some examples include camera surveillance in high risk areas, keeping prescription pads in locked locations, implementing a clearly defined process for controlling and accounting for keys, rules against sharing passcodes, utilizing bar codes for tracking, deploying secure and locked delivery carts, and using tamper resistant packaging.
"Hospitals and other health care providers routinely and regularly review records of administered controlled substances to determine if there is a pattern that may be indicative of diversion," said Lawrence Massa, president of the Minnesota Hospital Association. "Our hospitals take this work very seriously and have policies and procedures to detect diversion. But because controlled substance diversion is a serious issue that can lead to potential patient harm and or patient safety issues, organizations will be encouraged to proactively collaborate with local law enforcement; communicate expectations to staff that they speak up when they become aware of an issue related to diversion; and put in place training and education programs for staff."
One significant result of the coalition's work was to analyze data from the U.S. Drug Enforcement Administration (DEA) to compile statewide statistics about the incidence of health care worker controlled substance diversions in Minnesota, in the Minnesota Controlled Substance Diversion Prevention Coalition Final Report.
The data indicate that health-care-worker controlled substance diversions parallel a national trend of increased abuse of prescription drugs. Controlled substances most associated with a theft or loss event were hydrocodone, oxycodone, hydromorphone, morphine sulfate, and fentanyl.
The DEA requires hospitals and other health care facilities to report the theft or loss of controlled substances. In Minnesota from 2005 to 2011, there were 250 reports of theft or loss of controlled substances. Reports increased from 16 in 2006 to 52 in 2010, a 325 percent increase. (Retail pharmacy thefts are not included in these numbers.)
Overall the prescription drug problem is the fastest growing drug problem in the nation, according to the Office of National Drug Control Policy. The public has more access to these drugs today than in previous times. The number of opiate prescriptions dispensed by U.S. retail pharmacies increased from 76 million in 1991 to 210 million in 2010 – triple the number. The number of prescriptions for stimulants increased from 5 million in 1991 to 45 million in 2010.
Pharmaceutical diversion in health care facilities needs addressing, but it is only a fraction of the overall prescription drug abuse occurring in Minnesota, according to Joe Cappello, Drug Enforcement Administration Diversion Investigator for the Minneapolis-St. Paul District Office.
In terms of demand and abuse, pharmaceuticals have increasingly become indistinguishable from illicit drugs such as methamphetamine, cocaine and heroin – pharmaceuticals are no less addictive or harmful when abused.
"Collaboration between law enforcement and hospitals is already helping to identify the problem, catch it early and prevent drug theft from happening," Cappello said.
More information, including links to the report, road map and tool kit, is available at http://www.health.state.mn.us/patientsafety/drugdiversion/.