Clinical Drug Diversion Costly

Clinical Drug Diversion Costly to Health Care Organizations – Clinical Pain Advisor – Mar 2019

U.S. health care organizations lost nearly $454 million due to clinical drug diversion in 2018, according to the 2019 Drug Diversion Digest, released by Protenus Inc.

This article is written from the viewpoint of “Practice Management”, which nowadays isn’t about “practicing medicine” but about how to make money from it. These folks measure opioids by money gained/lost.

THE DEA always brags about how many pills/doses of opioids they confiscate in their raids, but here opioids aren’t counted by the pill of the MME, but by the mighty dollar. 

The health care compliance analytics firm Protenus analyzed 324 diversion incidents reported in online news stories in 2018.

I’m literally shocked that they had to rely on the currently unreliable media to find diversion incidents.

The DEA is in charge of the whole “controlled medications” supply chain, from the factory to the patient, passing through multiple distributors and repeated repacking for shipments to pharmacies.

• How can there NOT be mandatory reporting of such incidents to the DEA?
• How can they NOT be tracking massive diversions from the supply chain at least as carefully as they track opioid-prescribing doctors?
• How can there NOT be a current list of diversion incidents for the DEA to monitor like they monitor individual opioid prescriptions in PDMPs?

I suspect there was and is massive diversion happening all along the supply chain as shipments are handed from one corporate entity to the next. Huge freight boxes of opioids are handled by railway employees, warehouse workers, and clerks.

I imagine temporary workers in low-level jobs with high turnover are trusted with unmonitored access to boxes of opioids and are probably not even drug tested because they aren’t using them “as prescribed”. Again, only legitimate end users are being monitored and restricted.

And, because researchers examined only incidents of diversion that were caught, it leaves open the possibility that massive quantities of opioids may have been diverted from the supply chain by criminals clever enough not to be caught.

Drug diversion was defined as “the transfer of a controlled substance from a lawful to an unlawful channel of distribution or use.”

Incidents varied by stage of resolution and included U.S. health care workers who had been

• discovered,
• reported,
• arrested,
• charged, or
• sentenced for diversion incidents.

Key insights were gleaned retrospectively from the aggregated dataset.

Let’s not forget how limited this dataset would be.

And let’s not forget that this dataset only includes cases that the media reported – and we know the media isn’t particularly interested in anything but stories that confirm the fantasy about “innocent victims of prescription opioids”.

The analysis showed that more than one-third of “reported incidents” took place in a hospital or medical center setting.

The “reported incidents” cannot be typical because they were selected for being clumsy enough to be caught and interesting enough to generate many “clicks”.

I’m sure there are many more that have not been caught and, because that implies the criminals were smarter, they wouldn’t have taken risks for any but the largest shipments with the largest profit potential.

So we really don’t know anything at all about possibly the biggest contributor of prescription pills to the black market.

Specifically, 45 percent of publicly reported incidents occurred within practice and pharmacy settings.

Just under one-third of reported diversion incidents (29 percent) involved physician practices, while long-term care facilities accounted for 18 percent of incidents

Doctors accounted for 37 percent of publicly disclosed diversion incidents (compared with 26 percent in 2017), while nurses were responsible for 30 percent (compared with 41 percent in 2017).

Per capita, West Virginia had the most public diversion events.

Based on 87 incidents, organizations lost 47.2 million pills or dosages to diversion incidents, with an average monetary amount loss to the organization of $16.2 million worth of prescription drugs (based on 29 incidents).

“With this information, health care organizations can better protect members of their workforce who might be vulnerable to drug abuse and keep patients safe from potential harms associated with diversion,” the authors write.

This is a typical mealy-mouthed, irrelevant, meaningless statement, versions of which appear with regularity at the ends of studies or reports involving opioids.

I become uneasy when people damage me (like deprescribing opioids) and justify it by the claim they are trying to protect me (from addiction, which I and 97% of patients don’t have).

• Are they going to “protect members of their workforce” from getting cancer by controlling every bite they eat?
• Are they going to “protect members of their workforce” from car accidents by forbidding them to drive?
• Are they going to “protect members of their workforce” from being distracted on the job by putting them in a room without windows?

Someday, we will learn about more supply chain diversion when the actors are caught and newspapers report it. Until then, the DEA is just sitting on their hands.