With widespread repercussions, the COVID-19 pandemic has significantly impacted healthcare, exacerbating pre-existing problems like drug diversion. According to a White House drug policy office analysis, in the first four months of 2020, the United States experienced an 11% year-over-year increase in overdose deaths. This spike can be attributed to changes brought on by COVID-19, such as social isolation and economic uncertainty. When considering the larger healthcare picture, it’s important to note how these changes also influenced the factors that contribute to drug diversion.
When healthcare operations shifted to accommodate COVID-19, a lot changed. Some of the changes affecting drug diversion were new personnel having access to drug cabinets, increased demand for different drugs, and new external factors that incited illicit drug use.
In this article, we provide a closer look at ways COVID-19 impacts drug diversion factors, including who, what, and why.
Tracking healthcare professionals over time and across hospitals within a system is vital for identifying drug diverters. With the expansion of ICUs due to the pandemic and a surge in hiring temporary healthcare staff, the pool of possible perpetrators and the opportunity for drug diversion has grown. Pair this rapid expansion of staff and locations with IT teams and resources shifting procedures, and the chance for drug diversion is ripe.
During the first coronavirus surge, there was an immediate need for help from outside healthcare workers. Recently retired health care workers answered the call for aid and reentered the workforce while many medical students rose to the challenge by expediting their graduation to join the front-line response as soon as possible.
At the start of the pandemic, many organizations had to adapt their onboarding processes, often causing delayed or abridged background checks and screenings for new employees. With these crucial screening processes altered, identifying individuals with a background of drug diverting behavior becomes increasingly difficult.
Shifted focus: Drugs tied to COVID-19 treatment
In the United States, opioid pain relievers, specifically Fentanyl, are the most commonly diverted drugs. Organizations are aware of this demand and closely monitor these types of drugs for diversion. However, the variable that has arisen during the pandemic is that medications related to the treatment of COVID-19 may become new targets for drug diversion. Recent data showed a 300% week-over-week increase in orders of chloroquine and a 70% week-over-week growth in orders of hydroxychloroquine. While hydroxychloroquine and chloroquine are not normally targeted for drug diversion, their relationship to combatting the coronavirus makes them more likely to be diverted, especially when supplies run low.
More reasons and more opportunity
Probably the most significant factor that has changed as a result of the COVID-19 pandemic is increased stress and burnout among healthcare workers, which contributes to a higher likelihood of them diverting drugs to self-medicate.
Additionally, healthcare professionals may find themselves in new environments with more opportunity to divert medications. With the shift in operations, staff may be under less surveillance. For example, by limiting the number of healthcare workers with access to patient’s rooms, the number of witnesses for medication waste and diversion decreases. Given the combination of increased access and stress, healthcare workers who normally don’t divert drugs may be tempted by the newfound opportunity. By implementing drug diversion programs, healthcare organizations can protect both practitioners and patients alike.
Maintaining constant vigilance
With the COVID-19 global pandemic at the forefront of healthcare systems’ priorities, it’s easy to overlook the ongoing problem of drug diversion. Institutions are focused on addressing the pandemic and may allocate fewer resources towards monitoring for diversion or put drug diversion projects on hold. However, it’s imperative to realize that the pandemic may be changing the factors that lead to diversion, making it more difficult to identify and expounding the problem. Now is the time to shift drug diversion policies and security measures to account for these changes and ensure that healthcare systems are prepared to consistently monitor drug diversion.
Effectively preventing drug diversion requires regimented protocols, multi-layered security solutions, and constant monitoring of activity trends and people over time. Implementing these safety and security measures diminishes the chances for diversion and protects the health of practitioners, patients, and the community as a whole.
Implementing a drug diversion program
While factors for drug diversion fluctuate, healthcare organizations can mitigate risk by implementing a multifaceted drug diversion program. This process begins with acknowledging drug diversion risk and gaining executive-level support for combating the issue. Forming a drug diversion committee and hiring a drug diversion specialist to oversee the program and spearhead efforts are crucial steps for long-term success. Recruiting staff to get on board with a drug diversion program requires training them to identify diverters and giving them the ability to report diversion anonymously.
Once a drug diversion program is initiated, the next step is monitoring diversion with behavioral analytics and artificial intelligence and then reporting diversion incidents to the Drug Enforcement Administration and law enforcement. When incidents are identified, organizations should offer rehabilitation resources to help diverters and addicts recover and get back to work.
Drug diversion is a continuous effort, and as healthcare organizations evolve to address the COVID-19 pandemic, it’s imperative they revise their drug diversion programs along the way.