As prescription drug abuse in the United States escalates, diversion of controlled substances is becoming an increasingly critical issue for hospitals and health system executives to monitor. In hospitals, diversion of controlled substances not only negatively impacts staff and places liability on the facility but it also affects patient safety, satisfaction, and in most cases, the hospital’s bottom line. As such, hospital executives are looking to pharmacy leaders to provide creative solutions to proactively prevent diversion and better control this evolving public health issue.
For Ohio-based Mercy Medical Center (MMC), the solution started with the implementation of a data-driven approach to prevent narcotic diversion. This approach evolved into a well-honed, collaborative process engaging stakeholders across the hospital to execute a unique combination of strategies around medication dispensing, waste disposal, and reconciliation.
Classified as an epidemic of abuse by the Centers for Disease Control and Prevention, prescription drugs are the most common drug choice by nearly one-third of people aged 12 years and older for first-time drug use, according to the National Survey on Drug Use and Health.1 In Ohio, prescription drug abuse is the cause of alarming rates of unintentional drug poisonings, with associated death rates increasing by 366% from 2000 to 2012.2
To address the issue of community access to prescription narcotics, Ohio established the Ohio Automated RX Reporting System (OARRS), a statewide system through which pharmacies report daily on their distribution of controlled substances. This system enables pharmacists to look up patient activity associated with controlled substance use across multiple pharmacies statewide—a model being employed increasingly in states across the nation.
Although systems such as OARRS enable better collaboration to curb prescription drug abuse in the community, diversion issues among hospital staff are another growing challenge for the healthcare C-suite to address. Further exacerbating this issue is the broadening scope of diverted medication types. Because schedule II controlled drugs are protected by lock and key, a number of schedule III, IV, and V drugs—such as alprazolam, lorazepam, and pregabalin to name a few—are now being diverted at higher rates due to their greater accessibility.
As is the case for hospitals across the nation, finding the resources to implement an effective drug diversion prevention program was a considerable challenge for the 476-bed MMC. Maintaining a medical staff of 620 members and an employee base of 2500, the organization needed to track a growing number of medications at risk for diversion, as well as monitor activity in traditional high-risk areas such as the operating room (OR) and emergency department and throughout all units in the hospital.