Drug Diversion in Long Term Care Communities Remains a Problem

A recent article in a North Carolina newspaper highlighted the problem of drug diversion in the long term care setting. According to the article, the number of drug diversion cases rose sharply from 2100 in 1998 to over 11,500 in 2009, and is still increasing. Some studies have indicated that 1 in 6 nurses at some point in their career will struggle with addiction and that number may in fact be higher for nursing aides or other medical technicians. Unfortunately, the long term care setting provides significant opportunities for drug diversion due to the significant amount of residents with dementia in the population and the particular drugs used to treat residents in these settings.

There are signs of drug diversion of which facilities should be aware. Missing medication or complaints of pain from residents who were supposedly administered pain medication, at least according to their medical records, are usually an indicator that there is potentially an issue. Further, delays between sign out of medication and administration of the medication to residents may also signal a problem.

Drug diversion is a crime of opportunity and facilities must put protocols in place to attempt to prevent drug diversion. Drug testing applicants (post offer) is a good starting point to helping potentially screen out employees with active drug problems. Facilities that do not drug test run the risk of hiring employees with active addictions that cannot only lead to drug diversion, but increased workers’ compensation and professional liability claims. While drug testing laws vary by state, some facilities also drug test post incident/accident. Facilities should have robust medication administration procedures, particularly for pain medications, special procedures for narcotic drug administration, and an active relationship with the facility’s long term care pharmacy to quickly identify missing medications and any anomalies.


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