WHO AM I HURTING? Drug diversion should never be thought of as a victimless crime.
Note: Photo is for illustration only. The person depicted is a model.

All the troublesome ingredients that can lead to drug diversion are intensified in anesthesia providers. They work in high-stress environments, they may suffer professional burnout and they have much easier access to opioids than most. They may also be prone to the false beliefs that they can stop any time, and that their knowledge and education will keep them from becoming addicted.

Diverters may steal drugs for themselves, for money, or for a friend who's addicted or in pain (see "Detecting Diverters: Signs Are Plentiful"). Regardless, if we choose to look the other way, we enable them. It can be tempting to do so. We sympathize with their stress. Or we don't want to subject colleagues to professional or legal sanctions. We may even fear reprisal.

Or we might just find it difficult to accept that a respected longtime coworker could do such a thing. So we make excuses. We give them lighter assignments to help alleviate stress. Or we complain to each other about suspected diverters, but don't take our concerns to the proper level. After all, what if I'm wrong?

But the longer someone is permitted to steal drugs, the greater the potential consequences. Reporting your concerns is the first step toward helping that person. When a coworker needs help, we owe it to ourselves, our profession and to him to help him get it. Providers have lost their lives because others chose not to get involved. Diversion might cost patients their lives, too. Abuse or addiction supported by drug diversion isn't a victimless crime.

Patients. Our patients needlessly suffer if they don't get the medications they need, or are given adulterated or contaminated drugs.

Employers. Surgical facilities lose the revenue associated with pilfered drugs and may have to deal with poor performance on the part of the diverter. They may also face civil liability for failing to recognize, address or prevent drug diversion. If a health-care worker's illicit drug use harms a patient, both the worker and the employer are liable.

Diverters. They can be infected by needles, unsanitary injection techniques or by blood-to-blood transmissions from a patient. They may expose themselves to felony criminal prosecution or civil malpractice actions. They could lose their professional licenses. They may even overdose and die.

SWITCH Percocet 5/325 (left) strongly resembles Tylenol.

Be on the lookout
Does your facility have systems in place to guard against theft and diversion of controlled substances? It had better, because as diverters fall deeper into the habit, they get more creative.

The most popular technique for diverting drugs is substitution. Instead of administering fentanyl, a provider may replace it or cut it with saline or sterile water. Improper charting and withdrawing of meds are also popular ploys, as is outright theft.

Opioids (painkillers, ketamine, propofol and inhalation agents) and benzodiazepines are the most commonly diverted drugs, according to CMS. Anything that's not in a blister pack is an easy mark. It's easy to replace a few Percocet with Tylenol or some other similar-looking pills.

If you don't closely watch your meds and lock your carts between cases, you're practically inviting drug theft. Double-lock controlled substances to prevent tampering. Monitor the dispensing records of all providers.

Augment pre-employment drug screening with frequent urine drug screening of small numbers of employees. The Internet is full of sites offering ways to beat the tests, so someone should witness all urine drug-screening tests.

Two staff members should do narcotic counts at the end of every shift or every day, and each person should actually be able to see the meds. They should never accept statements like, "There are 10 vials in this box," without actually seeing all 10. Waste must be witnessed, too. Don't sign for a waste if you didn't actually see it. OSM