Breaking Down the Benefits of Drug Diversion Programs

Tom Knight, CEO and founder of Invistics Corporation, recently discussed the results of a study, done by Porter Research, which showed that roughly 9 in 10 health care professionals have met or know someone who has diverted drugs, and 40% of hospitals lack programs to prevent this.  

According to a press release, participants who responded to the Porter Research survey revealed that they feel drug diversion “negatively impacts quality of care, has an adverse impact on patient safety and jeopardizes compliance, putting their organizations at risk.” Further, two-thirds of respondents say they are only “somewhat confident” in the effectiveness of their current organization’s diversion programs.

To better understand the results of the survey, we spoke with Mr Knight. He broke down the importance of having drug diversion programs and provided real-world applications of the survey findings for clinical practice.

Please introduce yourself including your name, title, affiliation, and your research background.

This is Tom Knight. I’m the CEO and founder of Invistics Corporation. We’ve been working for 20 years with the pharmaceutical supply chain, including health care facilities that want to keep very good control on their medications and inventory.

What existing data prompted the investigation by Porter Research?

Really two things. We had done an early survey, about two years ago, by Porter Research. We wanted to update the results since two years had passed.

Secondly, we’re leading a nationwide study funded by the National Institutes of Health to develop improved methods for detecting drug diversion in health care facilities. We wanted to gauge the progress of various methods for detecting diversion in the two years since that prior survey was issued.

Can you please briefly describe the study and its findings? Were any of the outcomes particularly surprising?

Sure. The study confirmed that diversion is happening quite often across the country. 70% of people responding to the survey felt that most diversion that’s happening in the US goes undetected. That’s a pretty striking finding.

It’s consistent with what we’ve seen in prior surveys. It reinforced that this is, unfortunately, a very common problem for our health care facilities across the US.

The findings were a little different than what we heard just two years ago, but sadly most was consistent. For example, less than half of the people that responded said they were very confident that their drug diversion program was effective. The majority basically lacked the confidence that their programs to prevent diversion are working.

A few other statistics to share, the vast majority of the people filling out the survey, 86%, personally met or knew someone who has diverted drugs. About half of those felt their organization could be at risk from fines that are levied, say, by the Drug Enforcement Administration, or they might not meet the audit requirements of their state boards of pharmacy or the Joint Commission.

It was striking how many people see this as a big problem. There were a few changes in the two years since we last asked people their perspective. One of the biggest changes we saw is that people are losing confidence in traditional methods for detecting drug diversion.

The traditional methods that have been around for about 20 years are monthly reports that are generated from their automated dispensing cabinets.

In the past, people relied on monthly reports showing what had been removed from those cabinets to detect diversion. We saw a large drop in the percentage of respondents who said ADC reports are effective at identifying or preventing drug diversion.

Two years ago, slightly more than 3/4 of people trusted those reports, but now it’s down to 52%, just more than half, which is a pretty striking change. As we dug into the details behind that change, we heard people say they didn’t trust those reports to detect diversion.

I can elaborate on why, but they basically said the monthly reports are not detecting diversion that’s happening, which is called a false negative, and the reports are falsely flagging people who are not, in fact, diverting, which is called a false positive.

That was the biggest change that we saw, that the old way of detecting diversion using these monthly reports is very steeply dropping off. The good news is that more and more of the people doing the survey recognize the value of more advanced analytics and machine learning.

65% said machine learning would be an effective tool. 84% said advanced analytics solutions would be effective. It’s an interesting result that the old approach of these basic monthly reports are losing confidence and the more advance analytics are gaining confidence.

What are the possible real world applications of these findings in clinical practice? How do these findings impact stakeholders? What should the different stakeholders know amongst each other?

I think the biggest real world application is the need for hospitals and other health care facilities to have diversion prevention programs. Roughly 40% of the survey respondents said their facilities don’t have a drug diversion program.

The very first real-world application is healthcare leaders must put diversion prevention programs in place.  That’s necessary because diversion is happening. If you don’t have a program, it will be undetected.

Without a program, your facility will be at risk of big DEA fines. You’ll be at risk of potential injuries to your patients and at risk of organizational reputational damage if someone in your facility is found to be diverting in a way that then hits the headlines of your local paper or television news channel.

That’s the first big, real world application—40% of facilities lack a diversion prevention program. That would be the very first thing, if you’re a leader in one of those organizations, that you should take from this study.

The second big takeaway is that if you’re relying on these monthly reports, you’re probably not going to detect the diversion that happens in your facility. You should be looking for more advanced analytics, more modern approaches that are going to be more effective at detecting these thefts.

That’s a direct tie in to the research that’s being funded now, that I mentioned, from the National Institutes of Health. It’s a nationwide study where they’ve had our company research different methods to better detect diversion.

It’s wonderful that those technologies are now available so that you can more effectively detect diversion than the old approaches dating back 20 years ago.

Are there future plans to expand upon this research or change the scope to look at something else?

There are. In fact, the original focus of the research was just inpatient acute care hospitals. That was the initial study and grant the NIH gave us. They loved the initial results from the research and asked us to expand twice already. Once into pharmacy and again into anesthesia.

That expansion’s underway now. We do have further plans to expand the scope so that it’s a variety of other health care facilities, not just acute care inpatient, but also outpatient facilities, ambulatory surgical centers, retail pharmacies, and other health care facilities where medicines could be diverted like skilled nursing facilities, rehabilitative facilities, senior living, and hospice.

They’re all areas where we’re seeing there’s a lot of diversion and an improved need for these detection methods.

Is there anything else pertaining to this research and it’s finding that you would like to add or comment on?

First off, I’d like to thank the NIH for seeing this as a big national problem and seeing that the technology is now available to help reduce the size of the problem. The other thing I’d like to add is the number one reason that we’re motivated to help is we see this as a big patient safety issue.

When we look at population health and we look at risks to patients that are visiting these health care facilities, diversion, sadly, is one of the biggest risks. I don’t know if you’re familiar, Julie, but a lot of patients, tragically, are getting infected by people who are diverting drugs.

Not to get into too many details, but it’s quite common that someone who’s stealing, say, injectable medications will inject themselves with that medication, replace that liquid with saline or something worse, and then that can get injected into the patient.

Unfortunately, people using intravenous drugs are commonly people with infectious diseases like HIV or hepatitis C. When this kind of diversion happens, patients can contract hepatitis C, HIV, or other diseases that result from having been injected with non sterile solutions.

Patient safety is the number one reason that we are motivated to reduce drug diversion. I think that’s worth mentioning as the biggest reason that your readers, I think, would want to step up and improve methods to prevent diversion in their facilities.