Clinician Brief: Drug Diversion

Key points

  • Drug diversion happens when healthcare providers obtain or use prescription medicines illegally.
  • Drug diversion puts patients at risk.

Overview

Some healthcare providers steal prescription medicines or controlled substances, such as opioids, for their own use. This behavior leads to unsafe situations like:

  • An impaired healthcare provider delivering substandard care.
  • Patients denied essential pain medication or therapy.
  • Healthcare providers spreading viruses or bacterial infections to patients by tampering with injectable drugs.

Addiction to opioids is a major driver of drug diversion.1

Prevention

Reminder‎

Healthcare facilities should have narcotics security measures and active monitoring systems to prevent and detect diversion activities.

If drug diversion is suspect, appropriate response by healthcare facilities includes:

  • Assessment of harm to patients.
  • Consultation with public health officials when they suspect medication tampering.
  • Prompt reporting to law and other enforcement agencies.

Outbreaks associated with drug diversion

CDC and state and local health departments investigate infection outbreaks from drug diversion and healthcare providers tampering with injectable drugs. These outbreaks showed gaps in prevention, detection, or response to drug diversion in U.S. healthcare facilities.

U.S. outbreaks associated with drug diversion by healthcare providers, 1983-2018

U.S. outbreaks associated with drug diversion by healthcare providers, 1983-2018
Year Cases Outbreak
2018 12 HCV infections associated with an emergency department nurse at a hospital in Washington 2
2018 6 Sphingomonas paucimobilis bacteremia associated with a nurse at a cancer center in New York 3
2015 7 HCV infections associated with a nurse at a Utah hospital 4
2014 5 Serratia marcescens bacteremia associated with a nurse in a post-anesthesia care unit at a hospital in Wisconsin 5
2012 45 HCV infections associated with a radiology technician at hospitals in New Hampshire, Kansas and Maryland 6, 7, 8, 9
2011 25 Gram-negative bacteremia associated with a nurse at a Minnesota hospital 6, 10
2009 18 HCV infection associated with a surgical technician at a Colorado hospital 6, 11
2008 5 HCV infections associated with a radiology technician at a Florida hospital 6, 12
2006 9 Achromobacter xylosoxidans bacteremia associated with a nurse at an Illinois hospital 6, 13
2004 16 HCV infections associated with a certified registered nurse anesthetist at a Texas hospital 14, 6
1999 26 Serratia marcescens bacteremia associated with a respiratory therapist at a Pennsylvania hospital 15
1992 45 HCV infections associated with a surgical technician at a Texas ambulatory surgical center 16
1985 3 Pseudomonas pickettii bacteremia associated with a pharmacy technician at a Wisconsin hospital 17

Resources

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. Berge KH et. al., Diversion of drugs within healthcare facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention. Mayo Clin Proc.2012; 87(7):674-682.
  2. Njuguna HN, Stinson D, Montgomery P, Turner N, D'Angeli M., Carr J., et Hepatitis C Virus Potentially Transmitted by Opioid Drug Diversion from a Nurse—Washington, August 2017–March 2018. Morbidity and Mortality Weekly Report. 2019; 68(16), 374.
  3. Wasiura J, Segal B H, Mullin KM. Cluster of Sphingomonas paucimobilis Bacteremias Linked to Diversion of Intravenous Hydromorphoneexternal icon. N Engl J Med. 2019; 381(6), 584-585.
  4. Utah Department of Health. Utah Health Status Update: Hepatitis C and Drug Diversion. April 2017.
  5. Schuppener LM, Pop-Vicas AE, Brooks EG, Duster MN, Crnich CJ, Sterkel AK, et al. Serratia marcescens bacteremia: nosocomial cluster following narcotic diversion. Infect Control Hosp Epidemiol. 2017; 38(9), 1027-1031.
  6. Schaefer MK, Perz JF. Outbreaks of infections associated with drug diversion by healthcare personnel, United States. Mayo Clinic Proceedings.2014; 89 (6).
  7. New Hampshire Department of Health and Human Services, Division of Public Health Services. State of New Hampshire hepatitis C outbreak investigation Exeter Hospital public report. June 2012
  8. News Release. State health officials provide update in the case of potential hepatitis C exposures at Hays Medical Center. August 2012.
  9. Walker AK. 1,750 had possible contact with technician with hepatitis C. Baltimore Sun. August 12, 2012.
  10. Minnesota Department of Health, Infectious Disease Epidemiology, Prevention and Control Division. Outbreak of gram-negative bacteremia at St. Cloud Hospital. Investigation Summary, Minnesota Department of Health, 2011. Sept 14, 2012.
  11. Ramer, H. Hepatitis C tests continue after medical tech David Kwiatkowski's arrest. HuffingtonPost. December 22, 2012.
  12. Hellinger WC, Bacalis LP, Kay RS, Thompson ND, Xia GL, Lin Y, Khudyakov YE, Perz JF. Health care–associated hepatitis C virus infections attributed to narcotic diversion. Ann Intern Med.2012; 156:477-82.
  13. Behrens-Muller B, Conway J, Yoder J, Conover CS. Investigation and control of an outbreak of Achromobacter xylosoxidans bacteremia. Infect Control Hosp Epidemiol. 2012;33(2):180-184.
  14. Lee KC, Scoville S, Taylor R, et al. Outbreak of acute hepatitis c virus (HCV) infections of two different genotypes associated with an HCV-infected anesthetist [Abstract]. Poster session at 43rd Annual Infectious Diseases Society of American Annual Conference. San Francisco, CA; October 8, 2005.
  15. Ostrowsky BE, Whitener C, Bredenberg HK, et al. Serratia marcescens bacteremia traced to an infused narcotic. N Engl J Med. 2002;346(20):1529-1537.
  16. Sehulster L, Taylor J, Hendricks K, VanEgdom M, Whitely S, Manning S. Hepatitis C outbreak linked to narcotic tampering in an ambulatory surgical center [Abstract]. Program and Abstracts of the 37th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology. 1997; 293.
  17. Maki DG, Klein BS, McCormick RD, et al. Nosocomial Pseudmonas pickettii bacteremias traced to narcotic tampering: a case for selective drug screening of health care personnel. JAMA. 1991;265(8):981-986.