Stretched to Their Limit, Doctors and Nurses Account for 67% of Drug Diversion in 2020

Healthcare workers endured truly extenuating circumstances this past year, from personal protective equipment shortages to makeshift morgues, and the toll on their wellbeing is gradually becoming clear. In November 2020, a Yale School of Public Health survey of workers at 25 U.S. medical centers found that nearly a quarter of the 1,132 respondents had probable post-traumatic stress disorder.

"Healthcare workers have been thrust onto the front lines, exposed to a deadly virus daily," said Paul Gionfriddo, president and CEO of Mental Health America, in December. A survey conducted by the organization showed that 93 percent of healthcare workers were experiencing stress, and 86 percent were experiencing anxiety. 

Stressed and exhausted, doctors and nurses were responsible for the majority of publicly reported drug diversion incidents in 2020. Download the 2021 Diversion Digest for valuable insights on the impact diversion has had on the healthcare industry.

A lot has happened in the few months since those findings were published. The majority of American adults have gotten shots, and over a million more every day are receiving their first dose. Even beleaguered healthcare workers "are now seeing the light at the end of the tunnel," an April 2021 analysis by KFF/The Washington Post found. Still, "there may be some longer term impacts on those who were at the forefront during this global pandemic," researchers said.

Of particular concern is the KFF/Washington Post finding that 16 percent of 1,327 frontline worker respondents said their alcohol or drug use increased due to COVID-19-related worry or stress. As some medical professionals turn to excessive alcohol consumption or drug use to manage pandemic-related mental health issues, a concerning potential ramification that could affect patient care quality and elevate organizational risk.

Coping with trauma

The combination of high stress among clinicians and easy access to powerful, addictive medications was a recipe for disaster even before the pandemic, and data from the recently published 2021 Protenus Drug Diversion Digest reflect that this remains an unfortunate reality.

Consistent with 2019, doctors and nurses were responsible for the majority of drug diversion activity in 2020, according to the Diversion Digest. Doctors were the diverters in 36 percent of incidents where that information was available, and nurses were the diverters in 31 percent of incidents, for a combined total of 67 percent.

Though this percentage decreased from 2019, when doctors and nurses together accounted for 77 percent of diversion activity, it's important to understand that drug diversion detection and monitoring may have been stifled as hospitals reallocated resources to COVID-19 response efforts. With the link between high stress and substance abuse by medical professionals well-documented — and their stress clearly magnified amid the pandemic — Protenus believes that the scope of drug diversion by health workers was even greater than public reports were able to reflect.

What we owe clinicians

Doctors and nurses have made unimaginable sacrifices this past year to save lives and slow the spread of COVID-19. Clinicians felt the weight of caring for dying patients whose loved ones were desperate for good news, and they kept distance from their own families for fear of spreading the terrifying virus. One 40-year-old nurse told Yale researchers how painful it was to stop her son from hugging her after a long day at the hospital. 

"The look of sheer confusion and disappointment on his face has stayed with me all of these weeks. I cannot get that image out of my head," she wrote.

For these sacrifices and tireless efforts to fight COVID-19, hospitals owe doctors and nurses fervent commitment to protecting their wellbeing. That includes working to identify clinicians who are struggling with substance abuse and connecting them to the resources they need. 

Common signs of addiction among medical professionals include changing jobs frequently, preferring shifts when there is less supervision, falling asleep on the job, or being absent without explanation. However, relying on a clinician's equally overwhelmed colleagues to spot and report these red flags is not a foolproof strategy.

Instead, the compliance professionals responsible for preventing drug diversion can facilitate early detection of concerning behaviors by using automated, artificial intelligence-powered analytics. This kind of advanced technology provides complete monitoring of all medication use transactions, identifies unusual patterns based on several underlying data feeds, and notifies teams of potentially problematic activity requiring human investigation. Ultimately, the hospitals that use prevention-focused compliance analytics to successfully uncover drug diversion can steer diverters to the resources they need. 

In the absence of such sophisticated solutions, hospitals' compliance teams manually audit just a small fraction of all medication administration activity, allowing larger patterns indicative of drug diversion to go undetected. By extension, clinicians can continue diverting drugs to cope with the emotional toll of the pandemic, putting themselves, their patients, and their organizations in harm's way. 

Download the 2021 Protenus Diversion Digest to learn about how the issue affected healthcare organizations, employees, and patients amid the pandemic.