Last week’s Management Tip described a rather holistic view of risk management and information technology (IT) systems that can be used in a broader sense to help manage these risks. This week's Tip focuses on a particular aspect of risk management; specifically, the risk of drug diversion. Drug diversion has been described in any number of ways, but we typically think of it as the transfer of a drug (usually a controlled drug) from the person for whom it was intended to another person for any illicit use. In essence, it is theft. Drug diversion, and attempts at it, likely have been problematic since the availability of such drugs; however, given the increased prevalence of addiction in the midst of the U.S.’s opioid crisis, drug diversion has become more problematic.

Draime et al described the extent of drug diversion ongoing in 9 U.S. states by examining state board of pharmacy records.¹ Over the course of 5 years, they examined the records of 811 diversion cases in those 9 states. Controlled substances were involved in 94.2% of cases. Diversion for personal use was the outcome in 46.6% of cases, and technicians were involved in 71.4% of those cases. After all, technicians might not inherently be less moral, but they have much less to lose if caught and might require greater training in ethical reasoning. Freeman et al describe the use of prescription drug monitoring programs (PDMPs) as a mechanism to mitigate both diversion and patient misuse of controlled drugs, thereby mitigating risk and promoting patient safety.² Pharmacists in this study reported the positive implications for use of PDMPs but also discussed how even more effective use could be ensured by integrating the PDMP system into existing pharmacy dispensing systems and electronic health records rather than having employees log on to a “separate machine”.

Pharmacy managers must be acutely aware of various risks. Among the most prevalent risks in contemporary practice is drug diversion. There are available tools and even some regulatory mandates to curb the potential for diversion; however, pharmacists must not only be aware of and know how to maximize the benefit from these tools but also keep careful watch over inventory and make the best hiring and training decisions possible in regard to pharmacists and support personnel.  

Additional information about Risk Management in Contemporary Pharmacy Practice and Managing Medication Use Process Supporting Technologies and Automation can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.

¹Draime JA, Anderson DC, Anderson TS. Description and comparison of medication diversion in pharmacies by pharmacists, interns, and pharmacy technicians. J Am Pharm Assoc. 2018;58:275-280.

²Freeman PR, Curran GM, Drummond KL, Martin BC, et al. Utilization of prescription drug monitoring programs for prescribing and dispensing decisions: Results from a multi-site qualitative study. Res Social Adm Pharm. 2018; doi: 10.1016/j.sapharm.2018.09.007.