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BACKGROUND: Drug diversion can be defined as any criminal act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient. Drug diversion activities are a major driver of prescription opioid abuse and misuse, which have reached epidemic proportions in some areas of the country.
METHODS: We reviewed information pertaining to drug sales, prescription drug overdose, substance abuse disorders among healthcare personnel, infectious disease outbreaks stemming from drug diversion, and related public health laws and codes.
RESULTS: The rate of pharmaceutical drug abuse has grown significantly in recent years. As of 2006, nearly 7 million person were abusing prescription drugs in the U.S., an 80% increase over the year 2000, overtaking the number of persons abusing cocaine, heroin, hallucinogens, and inhalants combined. The number of overdose deaths has increased steadily over the last decade. In 2008, more than 36,000 people died of drug overdoses in the U.S., with the majority (20,000) from prescription drugs. Opioid drugs such as OxyContin (oxycodone), Vicodin (hydrocodone), and methadone are driving this increase. In 2008, nearly 15,000 people died from overdoses involving these drugs, a three-fold increase over 1999. Sales of these drugs have increased 300% in the last decade. While there are no reliable national estimates of the prevalence of drug diversion activities by U.S. healthcare personnel, access to narcotics may represent an underappreciated occupational hazard and patient safety risk. One recent study examined substance abuse disorders among anesthesiology residents; the prevalence was nearly one percent, with fentanyl and other intravenous opioids accounting for 57 percent of reports. Harms to patients from healthcare personnel who divert opioids may take many forms, including infection risks stemming from tampering with injectable drugs. For example, since 2004, there have been 4 hepatitis C outbreaks associated with infected healthcare workers who diverted fentanyl, involving more than 25,000 potentially exposed patients.
CONCLUSIONS: Basic public safety and patient safety demand effective, reliable safeguards to maintain the security of prescription opioids in both healthcare settings and the community. State and federal partners can work together to strengthen protections in this area, focusing attention on enhancing public health surveillance, identifying, evaluating, and disseminating promising policies, and improving clinical practice and public awareness.