May 2022
The following are several drug diversion news stories that have captured our industry’s attention.
A travel nurse leaves fears of hospital drug tampering across three states
Travel nurse Jacqueline Brewster was arrested in Kentucky in response to a warrant in neighboring Tennessee. Brewster was suspected of withdrawing vials of Dilaudid from hospitals in Tennessee and West Virginia, then replacing the drug with another liquid before gluing the vial caps back on. A nurse at Johnson City Medical Center in Tennessee flagged a suspicious vial, which led to an internal investigation that led to Brewster’s firing and subsequent arrest. Her tampering potentially contaminated the medications of over 100 patients across three states.
Montana nurse pleads guilty to drug charges
Nichole Lynn Zinda admitted to charges of diverting drugs from St. James Healthcare in Missoula, Mont. Zinda worked as a registered nurse on the post-operation floor. Records showed she had an unusually high number of transactions involving the painkillers oxycodone and hydromorphone compared to her peers. Zinda would pretend to give the substances to patients or waste them but would pocket the drugs instead. She faces a sentence of up to four years in prison.
US passes one million overdose deaths since records began
The Center for Disease Control (CDC) announced an estimated 107,622 deaths from overdose in 2021, a record year for such fatalities and a 15 percent increase from the year prior. The figure pushed the total number of overdose deaths to over one million since the CDC began collecting such data in 1999. The number was fueled by teenage deaths doubling in the last three years, many times driven by school, peer pressure and mental health issues.
Automated medication dispensing may cause drug mix-ups
Following the high-profile conviction of RaDonda Vaught, a former nurse accused of accidentally giving a fatal dose to an elderly patient at a Nashville hospital, safety advocates are requesting the makers of automated dispensing cabinets (ADCs) to update how to search for medications on their ADCs. The current process is to type in two or three letters to search for medicines in the cabinets. The Institute for Safe Medication Practices (ISMP) says that requiring users to insert at least five letters on ADCs can reduce these types of medication errors. ISMP believes the number of medications getting mixed up is probably high since hospitals are not required to report these types of errors.
Doctor accused of writing false prescriptions, taking medication for herself
Editor’s note: The charges in this case were dropped in December 2022 and expunged. The suspect’s name has been removed from this story.
A doctor from the Medical University of South Carolina was arrested on charges of writing false prescriptions for Ambien, a sleep medication, for her personal use. The doctor admitted to developing a drug addiction while treating patients during the COVID-19 pandemic. The doctor allegedly prescribed the drug to patients but would then take the medication for personal use. She learned about the criminal charges while at an addiction treatment center she admitted herself into.
Newark doctor arrested for allegedly forging signatures to obtain opioids
A former resident at Beth Israel Medical Center in New Jersey allegedly forged other doctors’ signatures to obtain controlled substances like Percocet, Adderall, Xanax, and Cialis. Sagy Grinberg was arrested for charges of forgery and fraud following an internal investigation at the New Jersey hospital. In March 2021, a pharmacy notified a doctor of the scripts he purportedly wrote for Grinberg. That doctor notified the authorities, which conducted an investigation that led to Grinberg’s resignation from Beth Israel and his eventual arrest.
Florida secures $860M from CVS, others to settle opioid case
State officials in Florida announced that drug store company CVS, Teva Pharmaceuticals, Endo Health, and Allergan would pay the state a combined $860 million to settle a case on the opioid epidemic. The state had previously filed a lawsuit against the companies alleging that their negligence led to mounting numbers of opioid addictions that cost the lives of thousands of Floridians. The settlement money will be distributed to state and local authorities for use exclusively in tackling the opioid crisis. In addition, Teva agreed to provide the state about $84 million in Narcan products to to treat overdose victims.
A nurse’s death raises the alarm about the profession’s mental health crisis
Michael Odell was a travel nurse who last worked at Stanford Health Care in California. When he did not come home after a stressful shift, his friends started a search that resulted in Odell being found dead. His death was determined as a suicide, which underlined the heavy toll on his profession’s mental health. Friends and colleagues have since pushed for a policy to help nurses receive more help from their employers and connected with veteran groups on how to help nurses deal with their PTSD on the floor. They have also started Don’t Clock Out, a peer support group that offers health care workers someone to speak to.
DEA recognizes first ever National Fentanyl Awareness Day
The Drug Enforcement Administration (DEA) recognized May 10 as the first National Fentanyl Awareness Day by asking Americans to talk with friends and family “about the dangers of this deadly drug.” The day was marked by the CDC’s announcement that nearly 107,000 Americans had died due to overdose in 2021, 66 percent of which involved synthetic opioids like fentanyl. The recognition was originally proposed by “Song for Charlie,” a nonprofit raising awareness of the drug’s use in fake prescription pills, among other civic organizations.
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Drug diversion is not just limited to opioids
Michael Pruett, MBA, RPh
Drug diversion is becoming a more widely known issue in hospital circles. With the Drug Enforcement Administration (DEA) and other government agencies trying to curtail the ongoing opioid crisis, practitioners are now under a lot of stress to treat their patients and comply with controlled substance regulations.
But while controlled substance diversion in hospitals may get the headlines, Michael Pruett thinks the diversion of non-controlled substances should get just as much attention. The now-retired co-founder of analytical testing laboratory DYNALABS says that drug diversion goes back decades and even centuries but may not have been seen as much of a problem in years prior.
“When I was fresh out of pharmacy school, I would see doctors writing prescriptions for themselves and pharmacists taking stuff home with them,” recalled Pruett. “When the laws changed, they still found ways to skirt regulations and get what they needed. Their colleagues would just look the other way.”
Pruett attended St. Louis College of Pharmacy for his undergraduate studies before earning an MBA from Webster University. As a young pharmacist, he would see colleagues take drugs home without a prescription for seemingly harmless reasons – a colleague would pocket blood pressure medication, while another would get antibiotics for his children’s ailments.
“We knew the pharmacology – how a drug is going to act, its half-life, what not to take it with,” said Pruett. “But once you take one drug, where does it stop?”
Pruett warns that diverting non-controlled substances – anything from heart medications to even Botox – is only a slippery slope to more dangerous drugs. For example, a nurse that takes an over-the-counter painkiller to stay on the floor could be one escalation away from an overdose. Beyond the fact that taking any legend drug without a prescription is not legal, some may assume these may not be as harmful as counterparts like fentanyl. Pruett says that’s a mistaken assumption.
“Diversion has become synonymous with narcotic theft,” said Pruett. “You may think of it as a nurse tampering with a patient’s fentanyl, but it does not look at the whole picture – it is just as much of a problem for hospitals if they are losing thousands or even millions’ worth of Botox injections. And it is just as much a problem for safety if they are being trafficked, or consumed, outside of the hospital.”
Pruett adds that looking at drug diversion as a problem solely focused on opioids only worsens a facility’s problems. Hesitant administrators are more likely to say there is no diversion at their facilities if they discount the non-controlled substances.
“Ignoring their diversion creates a reactive leadership culture,” said Pruett. “It creates administrators that aren’t too concerned with drug diversion until patient safety is compromised – or until a health care worker overdoses on the floor. It can get out of hand quickly.”
“Diversion comes in all shapes and sizes,” added Pruett. “Never discount the potential of why your staff is taking stuff out and using or selling. Any hospital administrative staffer who thinks there’s no drug diversion going on at their hospital needs to open their eyes because it’s happening – at all levels and at all times, and for virtually every type of drug out there.”
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