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Drug Diversion Training

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Drug Diversion Training DRUG DIVERSION TRAINING NOAH CARPENTER, MD Dr. Noah Carpenter is a Thoracic and Peripheral Vascular Surgeon. He completed his Bachelor of Science in chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of the Native Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, the Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education. DANA BARTLETT, RN, BSN, MSN, MA, CSPI Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 25 years at a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, written textbook chapters, and done editing and reviewing for publishers such as Elsevier, Lippincott, and Thieme. He has written widely on the subject of toxicology and was a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center. 1 NurseCe4Less.com ABSTRACT Drug diversion can take many forms and there are common ways in which drugs are diverted. As the availability and scope of prescription drugs have expanded to include a range of opiates, non-opiate depressants, stimulants, and potent cold medicines, so too have the misuse of these substances and the tendency to use them recreationally. It is important for all members of the interdisciplinary health team, including prescribers, pharmacists, and nursing staff, to be aware of the different strategies for drug diversion as well as the common characteristics of patients or coworkers with a substance use disorder. There are also preventative measures that healthcare facilities and clinicians may or must use to help reduce the incidence of drug diversion. These include organizational policies mandated by the U.S. Department of Justice and the Drug Enforcement Agency, prescription drug monitoring programs, Federal guidelines for proper storage and security regarding controlled substances, and guidelines for ordering, prescribing, preparation and dispensing of prescription drugs or controlled substances. 2 NurseCe4Less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. Continuing Education Credit Designation This educational activity is credited for 3 hours at completion of the activity. Statement of Learning Need Increasingly, all members of the interdisciplinary health team are required to update their knowledge and practices to recognize and prevent drug diversion. Current federal and state laws require health administrators to develop drug diversion prevention programs that include mandatory training by all members of the interdisciplinary health team to recognize and report a substance use disorder and suspected drug diversion activities. Course Purpose To provide knowledge for all members of the interdisciplinary health team who are expected to be compliant with the regulation of controlled substances, and to recognize and report the signs of drug diversion. Target Audience Advanced Practice Registered Nurses, Registered Nurses, and other Interdisciplinary Health Team Members. Disclosures Noah Carpenter, MD, Dana Bartlett, RN, BSN, MSN, MA, CSPI, Kellie Wilson, PharmD, William Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures. There is no commercial support. 3 NurseCe4Less.com Self-Assessment of Knowledge Pre-Test: 1. Drug diversion is best understood as a medical and legal concept involving the transfer of any legally prescribed substance a. to the intended patient who then misuses it. b. that is on the Controlled Substance schedules. c. from the individual for whom it was prescribed to another person. d. that has no medical purpose. 2. True or False: Dextromethorphan is a medication that is used to reduce or suppress coughs associated with common viruses. a. True b. False 3. Individual drug diverters may include a. patients. b. healthcare workers. c. drug dealers and drug addicts. d. All of the above 4. Fentanyl is an ________ and it is frequently diverted. a. opioid b. stimulant c. benzodiazepine d. depressant 5. ________________________, which are common ingredients in many over-the-counter cold medicines, are common ingredients in the manufacture of methamphetamine. a. Opioids b. Stimulants c. Central nervous system depressants d. Pseudoephedrine and ephedrine 4 NurseCe4Less.com Introduction The increase in the availability of prescription drugs has led to an increase in diversion. Drug diversion is an illegal act. Drug diversion is a potential threat to patients who are the intended recipients of diverted drugs, individuals diverting drugs, and individuals who receive and misuse the diverted drug. Healthcare professionals who divert drugs are not only at risk of personal, physical harm from misuse of the drugs but they may also suffer loss of a professional license or face criminal prosecution. In order to address this problem, medical professionals need to know what constitutes drug diversion. They also need to know which class of drugs and specific drugs are commonly diverted, how they are diverted, and common profiles of drug diverters. There are prevention strategies that healthcare facilities must or should implement to reduce drug diversion. If a coworker is suspected of diverting drugs, the other team members need to know how to approach the coworker and when they must report drug diversion. Finally, there are recovery programs for healthcare diverters. The goal here is to reduce the incident of drug diversion. Drug Diversion and the Scope of the Problem “Drug diversion is a medical and legal concept involving the transfer of any legally prescribed substance from the individual for whom it was prescribed to another person.”1 Prescription drug diversion often involves redirecting controlled substances but diversion may include non-controlled substances.2,3 Diversion of non-controlled substances is rising.2,3 Prescription drug misuse and diversion are serious problems that may affect the intended beneficiaries of drugs, harm the public and cost programs like Medicare significant amounts of money.2 For the healthcare professional, drug misuse and diversion can have a profound impact on the professional’s career. A healthcare professional who is caught diverting drugs may face criminal prosecution, civil liability, as well as suspension or loss of his or her professional license.4 5 NurseCe4Less.com People have various motivations for drug diversion. Drug diversion certainly occurs when people have a substance use disorder and they want to alter their consciousness but many drug diversions occur for profit or because someone wants relief from physical pain.2 Drug Diversion and the Opioid Epidemic The opioid crisis in the U.S., has been attributed to aggressive prescribing practices and the prevalence of opioid misuse.5 Drug diversion has played a major role in the opioid epidemic as well. This has led to increases in opioid overdose-related deaths.5 The Substance Abuse and Mental Health Services Administration and the National Center for Health Statistics reported that during 2016, about 11.5 million people misused prescription opioid pain relievers.6 In spite of the attention to this epidemic, and the efforts to control the misuse of opioids, the data shows that these numbers are continuing to rise.6 Drugs that are Commonly Diverted There are different classes of drugs that are commonly diverted worldwide. They are benzodiazepines, opioids, stimulants, antipsychotics, anesthetics, and GABA agonists.7 Within these classes, specific drugs are the usual targets of the diverter. These are listed in Table 1.7 6 NurseCe4Less.com TABLE 1: COMMONLY DIVERTED DRUGS7 Class Drugs Benzodiazepines all (e.g., alprazolam, diazepam) Opioids all (e.g., fentanyl, oxycodone) dexamphetamine Stimulants pseudoephedrine methylphenidate olanzapine Antipsychotics quetiapine ketamine Anaesthetic drugs propofol gabapentin GABA agonists pregabalin According to the U.S. Drug Enforcement Administration, there are five classes of drugs that are most commonly misused in the United States: opioids, antidepressants, hallucinogens, stimulants, and anabolic steroids.1 Analgesics and antiretroviral drugs are also diverted and misused.8 Other over-the-counter medications are diverted for use in the manufacture of illegal drugs.9 Some classes of drugs play a more prominent role in drug diversion. In some cases, a class of drugs will impact a certain population (e.g., stimulants and adolescents) more
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