The recent case of narcotic tampering involving an unidentified Minnesota nurse, that allegedly used a syringe to steal patients’ IV pain medications surely has reminded managers, supervisors and owners of the dangers and liability they, and their practices face when one of our own diverts narcotics.  Many may wonder, how do we protect ourselves and our practice from narcotic diversion?  How do we insure our drugs are not stolen or worse, tampered-with.  In the Minnesota case, at least 23 patients had to be treated for symptoms of an unusual bloodstream bacterial infection from contamination due to tampered-with narcotics.

There are technologies available today to help thwart diversion.  Smart-event tracking safes (better than the dumb-non event tracking, double lock safes), drug analysis during reverse distribution, random drug tests of employees and management, thorough back ground checks on those who have access to drug security areas, and so on.  All the things previously listed cost money to implement.  For this article I’d like to discuss something that costs very little to implement and may be one of the more effective, if not the most effective tool your organization has at stopping diversion.

Allow me to ask the reader a question.  If I say mandatory reportable event, what do you think of?  As a California Paramedic, I think of child abuse and elder abuse.  While there is no Federal requirement to do so, most states have adopted something similar, hopefully this isn’t new to you.  What does this have to do with narcotic diversion?  Did you know there is something similar at the Federal level involving narcotic diversion?

Let’s look at Code of Federal Regulations 1301.91.  The long name is Title 21 - Food and Drugs, Chapter II - Drug Enforcement Administration, Department of Justice, Section 1301.91 Employee responsibility to report drug diversion.  For short we’ll call it CFR 1301.91.  It is five sentences long and reads as follows:

Reports of drug diversion by fellow employees is not only a necessary part of an overall employee security program but also serves the public interest at large. 

It is, therefore, the position of DEA that an employee who has knowledge of drug diversion from his employer by a fellow employee has an obligation to report such information to a responsible security official of the employer. 

The employer shall treat such information as confidential and shall take all reasonable steps to protect the confidentiality of the information and the identity of the employee furnishing information. 

A failure to report information of drug diversion will be considered in determining the feasibility of continuing to allow an employee to work in a drug security area. 

The employer shall inform all employees concerning this policy.

The first sentence outlines the why, " … serves the public interest at large."

The second sentence says the what, " … obligation to report such information to a responsible security official…"

The third sentence gives protection, " …employer shall treat such information as confidential…"

The fourth sentence gives a warning, " ... failure to report … will be considered in determining feasibility of continuing to allow an employee to work…"

The final sentence gives a sense of urgency, "The employer shall inform all employees concerning this policy."

How will CFR 1301.91 help your organization thwart narcotic diversion?  Those that would steal or tamper-with narcotics rely on the naivety, ignorance, and susceptibility to coercion of their fellow co-workers.  While making your employees aware of their responsibilities to report diversion may do little to lessen their susceptibility to coercion, it will go a long way to decreasing their naivety and ignorance to the reality of drug diversion, especially when coupled with education regarding why protocols are in place.  

Narcotic diversion and especially narcotic tampering needs to be discovered early.  There is a greater chance that that will happen if your workforce is educated about what narcotic diversion is and their responsibilities regarding it.  

During your new employee orientation, be it with someone fresh out of school, someone seasoned, or first day with a traveling nurse or doctor.  Management needs to be sure that it is made clear to the new employee that narcotic diversion, especially narcotic tampering will not be tolerated in your organization and that if caught, they will be handed over to law enforcement and their respective boards.  Management needs to be sure that the next words out of the person doing the new employee orientation is that your organization will provide assistance to anyone that self reports that they have a substance abuse problem and asks for help.  This can be for any addiction, be it alcohol, prescription drugs, illicit drugs, or any other addiction that can harm work performance.

I’ve been studying what I call the phenomena of narcotic tampering in Pre Hospital care for the past 3 years.  I’d like to share one more thing with you that will hopefully end this piece on a positive note. Those of us in the the field of EMS, Law Enforcement and Health Care suffer from higher than average (when compared to the general population) rates of substance abuse.  We thankfully also have greater than average rates of success in fighting this disease and getting into stable recovery.  Why?  We have more to lose.  The life style of someone that works in EMS, Law Enforcement and Health Care can be a great one.  The fear of losing that life style can be the carrot that gets someone into treatment and help they need to maintain their stable recovery.

It starts with you, engage your colleagues in a frank discussion on this most dark of subjects, narcotic abuse among our own people.  Remind them they have a federal responsibility to report drug diversion and that help is available for chemical addiction.