Risks of Healthcare-associated Infections from Drug Diversion
When prescription medicines are obtained or used illegally, it is called drug diversion. Addiction to prescription narcotics called opioids has reached epidemic proportions and is a major driver of drug diversion. This webpage focuses on diversion involving healthcare providers who steal controlled substances such as opioids for their own use. This can result in several types of patient harm including:
- Substandard care delivered by an impaired healthcare provider,
- Denial of essential pain medication or therapy, or
- Risks of infection (e.g., with hepatitis C virus or bacterial pathogens) if a provider tampers with injectable drugs.
CDC and state and local health departments have assisted in the investigation of infection outbreaks stemming from drug diversion activities that involved healthcare providers who tampered with injectable drugs. A summary of recent outbreaks is illustrated in the following timeline.
U.S. Outbreaks Associated with Drug Diversion by Healthcare Providers,
- National Association of Drug Diversion Investigators
- Minnesota Hospital Association Drug Diversion Prevention Toolkit
- Drug Diversion in Hospitals: A Guide to Preventing and Investigating Diversion Issues [Word - 137 KB]
- CDC Public Health Ethics Case Study, Unsafe Injections: Duty to Warn? [PDF - 264 KB]
- Premier Inc. Drug Diversion Website
- Substance Abuse and Mental Health Services Administration
- National Institute on Drug Abuse (NIDA)
State Health Department Reports:
- Minnesota Controlled Substance Diversion Prevention Coalition [PDF - 391 KB]
- New Hampshire Hepatitis C Outbreak Report [PDF - 3.93 MB]
- Public Health Vulnerability Review: Drug Diversion, Infection Risk [PDF - 1.04 MB]
Blogs, Commentaries, and News:
- Drug Diversion in Healthcare Settings - NEW Medscape Video Commentary
- Drug Diversion Defined: Consequences for Hospitals and Other Healthcare Facilities (CDC’s Safe Healthcare Blog, June 11, 2014)
- Drug Diversion Defined: A Patient Safety Threat (CDC’s Safe Healthcare Blog, June 3, 2014)
- Outbreaks Highlight Infection Risks Associated with Drug Diversion (CDC's Safe Healthcare Blog, June 2, 2014)
- Drug Diversion in Health Care Settings Can Put Patients At Risk for Viral Hepatitis(AIDS.gov Blog, May 2, 2014)
- Doctors, medical staff on drugs put patients at risk (USA Today, April 17, 2014)
- Why Aren't Doctors Drug Tested? (New York Times, March 12, 2014)
- Hospitals Address a Drug Problem (Wall Street Journal, February 23, 2014)
Selected Peer-reviewed Publications:
- Schaefer MK, Perz JF. Outbreaks of infections associated with drug diversion by healthcare personnel, United States. Mayo Clinic Proceedings.2014; 89 (6).
- Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical Overdose Deaths, United States, 2010.JAMA. 2013; 309(7):657-659.
- Warner DO et. al., Substance Use Disorder Among Anesthesiology Residents, 1975-2009.JAMA. 2013; 310(21):2289-2296.
- Hellinger WC, Bacalis LP, Kay RS, Thompson ND, Xia GL, Lin Y, Khudyakov YE, Perz JF. Health care–associated hepatitis C virus infections attributed to narcotic diversion. Ann Intern Med. 2012; 156:477-82.
- Berge KH et. al., Diversion of drugs within healthcare facilities, a multiple-victim crime: Patterns of diversion, scope, consequences, detection, and prevention [PDF - 323 KB].Mayo Clin Proc.2012; 87(7):674-682.
For information on safe injection practices visit CDC’s Injection Safety Websites:Information for Providers, Preventing Unsafe Injection Practices