Drug Diversion and Duke: A Data+ Team’s Project
By Juliana Zhang, published in our 2017-18 issue
Drug diversion is the act of a healthcare provider intentionally taking drugs from an approved hospital setting for the sake of non-sanctioned, non-medical purposes. These can include a variety of reasons such as distributing controlled substances to people for illicit drug deals, but the main motivation is personal use. The medical field has recognized this issue as a problem for over twenty years, but hospitals have done little to automate and streamline the process of identifying the healthcare professionals who divert drugs. Drug diversion occurs at a rate of 1% for hospital faculty per year and 1.6% for residents per year among anesthesia care providers across the nation (Epstein). It is also estimated that out of all providers in anesthesiology, 1 in 10 of them will end up diverting drugs at some point in his or her career (Epstein). Healthcare professionals’ stress due to working in high-intensity spaces for extended periods of time contribute to the issue, as the controlled substances they divert can be used for short-term relief.
Common drugs that are diverted are opioids and benzodiazepines for their pain relief and anxiety-reducing effects. These drugs include fentanyl, remifentanil, or morphine (opioids) and Xanax or Valium (benzodiazepines). Based on a survey done in 2005 on 111 residency programs, 19% of resident program directors reported at least one drug-diversion related fatality in their training program between the years of 1991-2001 (Collins). Recognition of the drug-diversion problem occurred in 18% of cases after the fatal or nearly fatal overdose had already occurred (Collins). Clearly, this is a major issue of concern since early recognition is vital to save the lives of providers. Patients would also benefit by avoiding potential harm from these impaired providers.
A Duke Data+ team took on this problem by creating a drug-diversion monitoring tool for use in the Duke University Medical Center. By analyzing drug transaction data provided from the Duke pharmacy, students put together monitoring dashboards and visualizations to aid in the detection of drug-diversion. More research and analysis needs to be done to put forth more comprehensive solutions to this issue, as it is one with many interdisciplinary subtleties, and of pressing urgency for those involved as either professionals or patients in the health care system.
Collins, G.B., McAllister, M.S., Jensen, M., & Gooden, T.A. (2005). Chemical Dependency Treatment Outcomes of Residents in Anesthesiology: Results of a Survey. Anesthesia & Anaglesia, 101, 1457-1462.
Epstein, R.H., Gratch, D.M., & Grunwald, Z. (2007). Development of a Scheduled Drug Diversion Surveillance System Based on an Analysis of Atypical Drug Transactions. Anesthesia & Anaglesia, 105(4), 1053-1060.
Lyu, J., Sumner, J., & Zhang, J. “Controlled Substance Monitoring Visualization for the Duke Medical Center.” Duke Data+. July 2017. Poster presentation.