I recently read a blog by Dennis Tribble, a fellow pharmacist and IHFDA member, posted in ASHP titled Why do we talk about preventing diversion? I agree with his “rant” (his word not mine!). We use the word prevention when we talk about mitigating the risks for diversion, but we must be mindful of the fact that no matter how much education there is, no matter how good our policies and procedures are, no matter how tight our chain of custody is, those with a substance abuse problem will find a way to divert the medications. Their need for that substance drives everything they do, and they are constantly thinking of how to get it done.
We, the diversion monitoring specialists, devote a few hours a day or week to discovering their methods while they devote every waking hour to formulating a plan. Along with formulating the how to of diversion, they spend hours on plausible excuses they can use when questioned. The best diversion methods will be invisible, meaning they mimic every day practice. Those of us looking take several factors into consideration when monitoring for the anomalies. Drug diversion monitoring takes years of honing the skill set. Even if a facility has a great diversion specialist, if the leadership team does not understand diversion, they will dismiss the diversion specialist’s concerns as sloppy practice, educate the diverter on how they just got caught, and place them back to work! There are so many things that go into a comprehensive program, and if any of the components are lacking, the program will catch some, but it will miss many.