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Drug Diversion and Impairment

Being Addicted in Healthcare

Snowball effect of addiction

Drug diversion and on-the-job impairment are both rapidly growing problems. The opioid epidemic is at a high, and prescription drug overdose is a leading cause of death in the United States. No one is immune from developing Substance Use Disorder. It can affect anyone regardless of age, ethnicity, gender, economic circumstance, or occupation.
Nurses and other healthcare professionals are susceptible to misusing drugs and being impaired while at work. This presents a bigger issue, since patients place their trust in these professionals. When a nurse or other provider is impaired while on the job, they cannot provide the excellent care that patients rightly expect.
Because of the growing problem of impaired practice coupled with the nation’s opioid crisis, many states have enacted laws that address the issue, including reporting, discipline, treatment, and recovery.

What is impairment in nursing?

Impairment among nurses is defined as being unable to provide safe patient care due to the use of a mood- or mind-altering substance and/or due to the presence of a physical condition or a distorted thought process caused by a psychological condition. Not only does working while impaired put patients at risk, it also threatens the health and safety of the nurse and coworkers and may create strain on the employer, whether it’s a small private practice or a large institution.
To address the problem, some states and other institutions provide education, training, and assistance programs in the area of impairment. Florida, for one, has passed legislation requiring all nurses (RN or LPN) to complete a continuing education course on “Recognizing Impairment in the Workplace” course in order to be eligible to renew their licenses.

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What is drug diversion in nursing and hospitals?

Drug diversion entails the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. It is a multidisciplinary issue, particularly involving pharmacy, nursing, and medical staff.
Nurses and other healthcare professionals are subject to reporting by their employers and colleagues as well as to other legal consequences for alleged drug diversion and/or failure to properly document medication administration. Awareness around this problem is especially acute in relation to the current epidemic of opioid misuse.
West Virginia, Delaware, and Michigan all require nurses to complete continuing education courses on the topic of drug diversion and responsible opioid prescribing in order to renew their licenses.

Nurses and other healthcare professionals are susceptible to misusing drugs and being impaired while at work. This presents a bigger issue, since patients place their trust in these professionals.

How does one report drug diversion and impairment in nursing?

Substance use disorder is an occupational hazard, and each nurse and other healthcare provider must be able to recognize signs and behaviors associated with impairment and to offer support for colleagues who need help.
It is important to know your employer’s policies and procedures and/or state laws before reporting a healthcare professional suspected of being impaired in the workplace or of potential drug diversion.
Recommended reporting steps include:

  • Observe and document in detail any unprofessional conduct.
  • Report your findings to your clinical manager or supervisor.
  • The supervisor should confront the healthcare professional about the allegations and provide concrete steps for an intervention, if needed.
  • Depending on the state, supervisors may be required to further report to various state agencies.
Assorted capsules, tablets and drugs

What’s next? Do drug diversion programs work?

Nurses and other healthcare providers can seek treatment for any substance abuse disorder both when they are reported as well as at their own initiative. Nurses are generally required by law to stop practicing until they complete treatment, although they may be able to work in another environment in order to meet their financial obligations.
There are typically multiple treatment levels available depending on the severity of the individual’s condition. Approval of such treatment programs varies by state.

  • Residential Treatment Programs: These programs are provided in a specialized substance abuse facility or in a designated unit within a hospital system and focus on helping individuals change behavior in a highly structured therapeutic setting.
  • Partial Hospitalization Programs: These programs provide structured treatment as an alternative to inpatient residential treatment. This generally includes intensive and regular treatment sessions in a therapeutic environment five days per week.
  • Intensive Outpatient Programs: Treatment sessions are provided regularly but less frequently than with partial hospitalization programs. These programs aim to provide intense treatment with less disruption to work, school, or family schedules.

In order to prevent relapse and after completing any level program, after-care in the form of regular meetings with a self-help group and/or counselors is highly recommended to support the new drug-free way of life.

Doctors notepad

How can one prevent prescription drug abuse and diversion?

Today’s healthcare goal should be providing safe pain care without increasing prescription drug dependence.
The Office of National Drug Control Policy, whose principal purpose is to establish policies, priorities, and objectives for the U.S.'s drug control program, has released the following prescription drug abuse prevention plan:

  • Educate patients and the general public on proper use, storage, and disposal of prescription medication and educate healthcare professionals to assure appropriate prescribing and improve accountability of prescribers and patients.
  • Monitor patterns of use through surveillance systems and controlled substance monitoring programs. Prescription drug monitoring programs help identify high-risk users and high-risk prescribers and improve accountability.
  • Proper medication disposal helps eliminate excess quantities of controlled substances and reduces the likelihood these drugs will fall into the wrong hands.
  • Laws can be enacted to regulate distribution and reduce access to “pill mills” (doctors, clinics, and pharmacies that prescribe or dispense powerful narcotics inappropriately). Laws that establish stricter classification systems also help diminish widespread access and thus reduce the availability of excess drugs.

This article is intended for informational purposes only. Always refer to your organization’s and state’s specific laws, rules, and/or policies regarding reporting impairment and drug diversion.



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