Controlled Substance Diversion Prevention

Establishes comprehensive standards for preventing, recognizing, and responding to controlled substance diversion in healthcare settings, including chain of custody requirements, waste management, detection methods, and recovery support for affected healthcare workers.

policies•Feb 2026•Patient Safety

Controlled Substance Diversion Prevention Policy

1. Policy Statement

It is the policy of this organization that all controlled substances shall be managed through a comprehensive Controlled Substance Diversion Prevention (CSDP) program that maintains secure chain of custody from procurement through administration and waste, supported by an organizational culture of safety that promotes prompt, confidential, and nonpunitive reporting of suspected diversion.12 Each controlled substance administration shall be accompanied by a valid order from an authorized prescriber. All healthcare team members with access to controlled substances shall receive role-specific training and demonstrate competency in controlled substance handling processes.34

2. Purpose

This policy exists to:

  • Protect patients from harm caused by diversion of controlled substances intended for their care.
  • Establish clear expectations for professional behavior, chain of custody, access controls, and waste processes throughout the controlled substance lifecycle.
  • Define a comprehensive CSDP program that empowers healthcare workers and leadership to create a safe, healthy work environment.
  • Establish detection, investigation, and reporting processes for suspected or confirmed diversion.
  • Support the recovery and safe return to practice of healthcare workers experiencing substance use disorders, treating addiction as a chronic illness requiring treatment rather than solely punitive response.56

3. Scope

This policy applies to:

  • All employees, contractors, agency staff, students, and volunteers with access to controlled substances in any organizational setting.
  • All controlled substances throughout the medication pathway: procurement, storage, dispensing, transportation, preparation, administration, and waste.
  • Pharmacy, nursing, physician, advanced practice, and allied health personnel who prescribe, dispense, prepare, administer, or witness waste of controlled substances.
  • All clinical settings within the organization, including inpatient units, emergency departments, perioperative areas, ambulatory infusion centers, home health, and hospice settings.78

4. Policy Requirements

4.1 Organizational Framework and Culture

4.1.1 Policies and Procedures. Organizational policies and procedures shall accurately reflect local and regional regulatory requirements in all aspects of controlled substance management.3910 Policies shall be reviewed at minimum annually and updated immediately when regulatory changes occur.

4.1.2 Stakeholder Collaboration. The CSDP program shall be developed and maintained through collaboration with key stakeholders including: Pharmacy, Providers, Nursing, Law Enforcement (as applicable), Vendors, Healthcare Leadership, Infection Prevention, Contracted Services, Risk Management, Human Resources, and Biomedical Engineering.412

4.1.3 Cultural Expectations. The organization shall establish and communicate clear expectations for professional behaviors that discourage abuse of controlled substances.1112 Research confirms that substance use disorders among registered nurses carry a prevalence that demands proactive institutional response rather than reactive discipline alone.11 Gender and occupational stress factors have been identified as significant predictors of diversion risk and shall inform prevention planning.13 These expectations shall be reinforced during orientation and regularly through education and leadership modeling.14

4.1.4 Reporting Culture. The organization shall communicate each employee’s obligation to recognize and promptly, anonymously report behaviors that may be associated with diversion.151 Reporting shall be confidential and nonpunitive. Retaliation against an individual who reports suspected diversion in good faith is a policy violation subject to disciplinary action.

4.2 Chain of Custody

4.2.1 A secure chain of custody shall be maintained for controlled substances at every point in the medication pathway.161 This includes: locked transport containers from pharmacy to unit-based storage, secured automated dispensing cabinets (ADCs) accessible only to authorized staff, and locked devices when controlled substances are transported from storage to the point of administration.

4.2.2 Automated Dispensing Cabinets. ADCs and medication-related automated systems shall require: initial and ongoing staff training and competency verification, regular validation of proper user access levels, regular review of override lists, ongoing system maintenance, and established downtime procedures.171819 Organizations should consider establishing interoperability between ADCs and the electronic health record to improve surveillance and detection capabilities.2021 Evidence demonstrates that ADC implementation meaningfully impacts nursing workflow and medication safety2223, and that governance processes for ADC-controlled drugs in high-acuity settings such as intensive care units require particular vigilance.18 Return-on-investment modeling may support institutional arguments for ADC upgrades or functionality expansion.2419 Downtime procedures shall ensure that chain of custody is not compromised during system outages.2117

4.2.3 Access Control. Access to controlled substances shall be restricted through: keys, biometrics, or badge access systems.2526 High-risk, high-volume areas shall be identified for enhanced surveillance and medication pathway controls.27 Camera surveillance should be considered for high-risk areas. Authorized staff shall not delegate their individual access credentials or share access to controlled substances in ways that alter chain of custody.

4.2.4 Patient-Supplied and Transferred Substances. The organization shall maintain processes to secure controlled substances that patients bring into facilities and substances that arrive with patients transferred from other facilities.16

4.3 Prevention Strategies

4.3.1 Opioid Stewardship. The organization shall implement an opioid stewardship program to optimize dosing, support multimodal pain relief, and educate patients and caregivers on diversion prevention.282930 The program shall address home care and hospice settings with specific procedures for controlled substance waste and shall include screening of patients and caregivers for history of addiction or risk of misuse where controlled substances are in active use.831 The organization shall investigate abuse-deterrent formulation preparations of oral opioids to reduce diversion potential.3233 High-misuse opioids such as fentanyl and immediate-release formulations represent elevated diversion targets requiring enhanced stewardship.34

4.3.2 Pre-Employment Screening. Background checks shall be conducted for all healthcare workers with access to controlled substances, consistent with applicable law and organizational policy.13536

4.3.3 Order Review. Clinical staff shall review controlled substance orders carefully for accuracy and appropriateness for individual patients.1 Electronic prescribing of controlled substances shall be used whenever possible. Paper prescription pads shall be secured so that only authorized individuals have access.

4.3.4 Administration Process Compliance. Controlled substances shall be stocked in ready-to-administer form in the lowest available units typically prescribed to minimize waste volume.167 Preparation shall occur as close to administration time as possible. Dose preparation shall be limited to single doses when possible. When delays occur between preparation and administration, chain of custody shall be maintained by the preparing clinician.37 Syringes containing controlled substances shall be labeled per organizational policy if not immediately administered, and control of the medication maintained at all times.27 Continuous infusions or patient-controlled controlled substances shall be administered through secure devices that prevent unauthorized access or tampering.38

4.3.5 Education and Training. Controlled substance diversion education shall be provided to all personnel with access to these medications—including unlicensed and contracted personnel—at initial orientation and regularly thereafter.11439 Training shall cover:

  • Professional responsibility to protect public safety.
  • Risk factors for substance use disorder, addiction, and diversion, including adverse childhood experiences and occupational stressors.401341
  • Signs, symptoms, and behavioral patterns that may indicate diversion.253638
  • Medications at high risk for diversion.26
  • Preventive measures in place within the organization.4
  • Proper documentation for all controlled substance transactions.
  • Diversion investigation processes.42
  • Civil, criminal, and disciplinary consequences of confirmed diversion.10
  • Professional obligation to report suspected diversion.15

4.4 Waste Management

4.4.1 Proper adherence to controlled substance waste processes is mandatory. Ethical and professional concerns related to waste—including conscientious objection to certain disposal methods—shall be acknowledged and resolved through policy and leadership dialogue while maintaining regulatory compliance.43 Waste shall occur at medication removal or promptly after administration within an organizationally established timeframe.116

4.4.2 An independent witness shall physically observe and validate the accuracy of volume or dose of medication to be wasted.3744 Partially filled vials and syringes discarded in sharps containers represent a documented and significant vector for drug diversion and shall not be used as a substitute for witnessed waste.44 The witness shall not be the same individual who removed the medication.

4.4.3 All waste receptacles shall be secured and tracked.45 Controlled substances shall be disposed of in a manner that renders them irretrievable and unusable.1 The organization should utilize waste products that convert controlled substances to non-retrievable states allowable for landfill disposal, including activated carbon-based deactivation systems.464748

4.4.4 The organization shall maintain processes for controlled substance tracking with prompt resolution of medications that are expired, unusable, returned, or subject to loss of chain of custody.4516

4.5 Recognition and Detection

4.5.1 Drug Testing. The organization shall implement drug testing as appropriate to detect potential diversion and impaired practice in accordance with local jurisdiction and governing board requirements.151

4.5.2 Waste Testing. Waste-testing technology may be implemented to detect saline replacement of controlled substances as a diversion tactic, particularly for propofol and infusion opioids which are documented high-risk agents for this form of substitution diversion.4447

4.5.3 Discrepancy Investigation. Controlled substance discrepancies shall be investigated and resolved promptly.249 Routine audits of the medication pathway shall be conducted to detect potential diversion.42920 Audits shall review: prescribing patterns for anomalies, system-generated reports for patterns and trends in medication retrieval, documentation for accuracy and unusual patterns, and patient pain management trends to identify deviations in actual medication delivery compared to documented administration.5051452 Advanced analytics and machine learning tools have demonstrated utility in identifying patterns consistent with diversion that are not detectable through manual review alone and should be considered as adjuncts to routine surveillance.53 Diversion by pharmacists and pharmacy technicians via data-entry and verification tasks has been documented and requires specific audit attention within pharmacy workflows.2052

4.5.4 Immediate Response to Impairment. When a healthcare worker is suspected of being impaired, organizational processes shall be activated immediately to: remove the individual from patient care delivery, prevent access to controlled substances while investigation is conducted, and initiate the organization’s impaired provider protocol.541525

4.5.5 Regulatory Reporting. Confirmed diversion and unaccounted loss of controlled substances shall be reported to proper entities in accordance with licensing, local laws, and regulations.10 The organization shall maintain systems to rapidly identify and manage infectious outbreaks attributable to controlled substance diversion, as documented outbreaks of hepatitis C and bloodstream infections have been traced directly to healthcare worker diversion events.555657

4.6 Recovery and Return to Practice

4.6.1 The organization shall establish and communicate processes to support the confidentiality and recovery of healthcare workers experiencing substance use disorders.5658 Substance use and addiction shall be regarded as chronic illnesses; organizational goals shall be retention, rehabilitation, and reentry into practice when appropriate and safe.5960 Social stigma toward individuals with opioid use disorder remains a documented barrier to help-seeking behavior and shall be actively countered through organizational culture and messaging.61

4.6.2 Alternative-to-discipline programs implementing evidence-based recovery strategies shall be utilized when permitted by the applicable licensing board and when consistent with patient safety.62 These programs are associated with increased success in supporting recovery and enabling safe return to practice.3563 The role of adverse childhood experiences and psychological trauma as predictors of relapse shall inform the design of support and monitoring programs.4140

4.6.3 The organization shall establish monitoring processes for healthcare workers returning to clinical practice after recovery to ensure patient safety is protected during the reintegration period.61

5. Compliance

5.1 Monitoring. Compliance shall be monitored through: regular audits of ADC access logs, override rates, and discrepancy patterns; waste witnessing compliance rates; annual controlled substance education completion rates; tracking of reported discrepancies and investigation resolution times; and regulatory audit outcomes.

5.2 Key Performance Indicators.

  • Controlled substance discrepancy rate and resolution time (target: all discrepancies resolved within organizationally defined timeframe).
  • Waste witnessing compliance rate (target: 100%).
  • Controlled substance education completion rate (target: 100%).
  • ADC override rate (target: year-over-year reduction).

5.3 Enforcement. Confirmed controlled substance diversion shall result in immediate suspension of access, investigation through the organization’s interprofessional diversion review process, reporting to applicable regulatory and law enforcement agencies, and disciplinary action up to and including termination.10 Failure to report known or strongly suspected diversion is itself a policy violation subject to disciplinary action.

6. Exceptions

6.1 In emergent resuscitation situations where controlled substance administration occurs without a pre-existing order, a verbal order shall be obtained from the responsible physician and documented in the patient’s health record within the organizationally defined timeframe, and waste shall be witnessed as soon as the emergency has stabilized.

6.2 No exception shall be granted to the requirement for witnessed waste or the prohibition on sharing access credentials.

  • ASHP Guidelines on Preventing Diversion of Controlled Substances1
  • ASHP Guidelines on the Safe Use of Automated Dispensing Cabinets17
  • ASHP Guidelines on Perioperative Pharmacy Services7
  • DEA Regulations on Controlled Substance Management
  • Organizational Impaired Provider Policy
  • Organizational Progressive Corrective Action Policy
  • Organizational Alternative-to-Discipline Program Policy
  • POL-009: Patient Education in Infusion Therapy
  • POL-012: Documentation in the Health Record for Vascular Access
  • Controlled Substance Diversion Reporting Form
  • Impaired Provider Response Protocol

8. Revision History

VersionDateAuthor(s)Description of Change
1.02026-02-23D. Woo, M. Stern, I.M. WrightInitial policy creation based on IVAPS standards
———Scheduled review date: 2027-02-23 or upon regulatory change, whichever occurs first

References

  1. Clark J, Fera T, Fortier C, et al. ASHP Guidelines on Preventing Diversion of Controlled Substances. Am J Health Syst Pharm. 2022;79(24):2279–2306. doi:10.1093/ajhp/zxac246 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

  2. Fan M, Tscheng D, Hamilton M, Hyland B, Reding R, Trbovich P. Diversion of controlled drugs in hospitals: a scoping review of contributors and safeguards. J Hosp Med. 2019;14(7):419–428. doi:10.12788/jhm.3228 ↩︎ ↩︎ ↩︎

  3. New K. Drug diversion regulatory requirements and best practices. Patient Safety and Quality Healthcare (PSQH). 2020. https://www.psqh.com/analysis/drug-diversion-regulatory-requirements-and-best-practices/ ↩︎ ↩︎

  4. Tellson A, Zetzsche MJ, Caauwe LJ, Cassity W, Patterson B. Drug diversion program: a comprehensive process for prevention and identification. Nurs Manage. 2022;53(2):12–19. doi:10.1097/01.NUMA.0000816244.46062.51 ↩︎ ↩︎ ↩︎ ↩︎

  5. Ross C, Berry NS, Smye V, Goldner EM. A critical review of knowledge on nurses with problematic substance use: the need to move from individual blame to awareness of structural factors. Nurs Inq. 2018;25(2):e12215. doi:10.1111/nin.12215 ↩︎ ↩︎

  6. National Council of State Boards of Nursing. Substance use disorder in nursing, a nurse manager’s guide. 2018. https://www.ncsbn.org/brochures-and-posters/a-nurse-managers-guide-to-substance-use-disorder-in-nursing ↩︎ ↩︎ ↩︎

  7. Hawkins B, Bickham P, Golembiewski J, Meyer T, Murray CG, Wagner D. ASHP guidelines on perioperative pharmacy services. Am J Health Syst Pharm. 2019;76(12):903–920. doi:10.1093/ajhp/zxz073 ↩︎ ↩︎ ↩︎

  8. Cagle J, Ware O. 15 Recommendations for Preventing Medication Diversion & Misuse in Hospice Care. 2019. https://hospicefoundation.org/hfa/media/Files/Preventing-Medication-Diversion-in-Hospice-Recommendations-10-28-2019.pdf ↩︎ ↩︎

  9. Videau M, Atkinson S, Thibault M, Lebel D, Bussieres JF. Compliance with recommended practices for management of controlled substances in a health care facility and corrective actions. Can J Hosp Pharm. 2019;72(3):175–184. doi:10.4212/cjhp.v72i3.2897 ↩︎ ↩︎

  10. Rousseau RR. Drug diversion in the health care system: cultural change via legal and policy mechanisms. Am J Law Med. 2020;46(4):446–468. doi:10.1177/0098858820975533 ↩︎ ↩︎ ↩︎ ↩︎

  11. Kunyk D. Substance use disorders among registered nurses: prevalence, risks and perceptions in a disciplinary jurisdiction. J Nurs Manage. 2015;23:54–64. doi:10.1111/jonm.12081 ↩︎ ↩︎

  12. Gu JK, Allison P, Trotter AG, et al. Prevalence of self-reported prescription opioid use and illicit drug use among U.S. adults. J Occup Environ Med. 2022;64(1):39–45. doi:10.1097/JOM.0000000000002328 ↩︎

  13. Milani SA, Lloyd SL, Serdarevic M, Cottler LB, Striley CW. Gender differences in diversion among non-medical users of prescription opioids and sedatives. Am J Drug Alcohol Abuse. 2020;46(3):340–347. doi:10.1080/00952990.2019.1708086 ↩︎ ↩︎

  14. North Carolina Healthcare Association. Diversion awareness education framework. 2018. https://www.ncha.org/wp-content/uploads/2018/06/Diversion-Awareness-Education-Framework.pdf ↩︎ ↩︎

  15. The Joint Commission. Quick Safety: Drug diversion and impaired health care workers. TJC. 2020;48. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-48-drug-diversion-and-impaired-health-care-workers/ ↩︎ ↩︎ ↩︎ ↩︎

  16. Lam P, Campbell A, Chynoweth T, et al. Standard of practice in dispensing and distribution for pharmacy services. J Pharm Pract Res. 2021;51(6):511–535. doi:10.1002/jppr.1785 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

  17. Cello R, Conley M, Cooley T, et al. ASHP Guidelines on the Safe Use of Automated Dispensing Cabinets. Am J Health Syst Pharm. 2022;79(1):e71–e82. doi:10.1093/ajhp/zxab325 ↩︎ ↩︎ ↩︎

  18. Lichtner V, Prgomet M, Gates P, Franklin BD. Automatic dispensing cabinets and governance of controlled drugs: an exploratory study in an intensive care unit. Eur J Hosp Pharm. 2023;30(1):17–23. doi:10.1136/ejhpharm-2020-002552 ↩︎ ↩︎

  19. Rhodes JAM, McCarthy BC, Scott AC. Automated dispensing cabinet functionality expansion to reduce controlled substance inventory discrepancies. Hosp Pharm. 2022;57(4):526–531. doi:10.1177/00185787211061380 ↩︎ ↩︎

  20. de Vries M, Fan M, Tscheng D, Hamilton M, Trbovich P. Vulnerabilities for drug diversion in the handling, data entry, and verification tasks of 2 inpatient hospital pharmacies: clinical observations and healthcare failure mode and effect analysis. J Patient Saf. 2022;18(1):e227–e235. doi:10.1097/PTS.0000000000000744 ↩︎ ↩︎ ↩︎

  21. Mason AN. Pharmacy internal controls: a call for greater vigilance during the COVID-19 pandemic. Pharmacy (Basel). 2020;8(4):216. doi:10.3390/pharmacy8040216 ↩︎ ↩︎

  22. Craswell A, Bennett K, Dalgliesh B, et al. The impact of automated medicine dispensing units on nursing workflow: a cross-sectional study. Int J Nurs Stud. 2020;111:103773. doi:10.1016/j.ijnurstu.2020.103773 ↩︎

  23. Berdot S, Blanc C, Chevalier D, Bezie Y, Maï Lê LM, Sabatier B. Impact of drug storage systems: a quasi-experimental study with and without an automated-drug dispensing cabinet. Int J Qual Health Care. 2019;31(3):225–230. doi:10.1093/intqhc/mzy155 ↩︎

  24. Bonnabry P, François O. Return on investment: a practical calculation tool to convince your institution. Eur J Hosp Pharm. 2020;27(2):111–113. doi:10.1136/ejhpharm-2018-001733 ↩︎

  25. Perry JC, Vandenhouten CL. Drug diversion detection. Nurs Manage. 2019;50(2):16–21. doi:10.1097/01.NUMA.0000552735.56577.4b ↩︎ ↩︎ ↩︎

  26. Kristoff T. Methods, trends, and solutions for drug diversion. IAHSS Foundation. 2018. https://iahssf.org/research/methods-trends-and-solutions-for-drug-diversion/ ↩︎ ↩︎

  27. Block FE, Azizi J, Markwell S. Case studies and considerations for combating the diversion of infusion drugs. J Clin Eng. 2018;43(1):18–21. doi:10.1097/JCE.0000000000000249 ↩︎ ↩︎

  28. Kharasch ED, Clark JD, Adams JM. Opioids and public health: the prescription opioid ecosystem and need for improved management. Anesthesiology. 2022;136(1):10–30. doi:10.1097/ALN.0000000000004065 ↩︎

  29. Al-Samawy S, Varughese N, Vaillancourt R, Wang XYW, Penm J. A global survey on opioid stewardship practices in hospitals: a cross-sectional pilot study. Pharmacy. 2021;9(3):122. doi:10.3390/pharmacy9030122 ↩︎

  30. Gondora N, Versteeg SG, Carter C, et al. The role of pharmacists in opioid stewardship: a scoping review. Res Social Adm Pharm. 2022;18(5):2714–2747. doi:10.1016/j.sapharm.2021.06.018 ↩︎

  31. Ware OD, Cagle JG, McPherson ML, Sacco P, Frey J, Guralnik J. Confirmed medication diversion in hospice care: qualitative findings from a national sample of agencies. J Pain Symptom Manage. 2021;61(4):789–796. doi:10.1016/j.jpainsymman.2020.09.013 ↩︎

  32. Nalamachu SR, Shah B. Abuse of immediate-release opioids and current approaches to reduce misuse, abuse, and diversion. Postgrad Med. 2022;134(4):388–394. doi:10.1080/00325481.2018.1502569 ↩︎

  33. Adler JA, Mallick-Searle T. An overview of abuse-deterrent opioids and recommendations for practical patient care. J Multidiscip Healthc. 2018;11:323–332. doi:10.2147/JMDH.S166915 ↩︎

  34. Schifano F, Chiappini S, Corkery JM, Guirguis A. Assessing the 2004–2018 fentanyl misusing issues reported to an international range of adverse reporting systems. Front Pharmacol. 2019;10:46. doi:10.3389/fphar.2019.00046 ↩︎

  35. Foli KK, Reddick B, Zhang L, Krcelich K. Substance use in registered nurses: “I heard about a nurse who…”. J Am Psychiatr Nurses Assoc. 2020;26(1):65–76. ↩︎ ↩︎

  36. Kaur Ghuman S, Maletich KCA. Drug diversion: best practices and support for a staff assessment process. Clin J Oncol Nurs. 2020;24(2):195–198. doi:10.1188/20.CJON.195-198 ↩︎ ↩︎

  37. Hertig J, Jarrell K, Arora P, et al. A continuous observation workflow time study to assess intravenous push waste. Hosp Pharm. 2021;56(5):584–591. doi:10.1177/0018578720931754 ↩︎ ↩︎

  38. Johnson QL, Borsheski R. Recognizing and preventing perioperative drug diversion. AORN J. 2019;110(6):657–662. doi:10.1002/aorn.12878 ↩︎ ↩︎

  39. Stewart DM, Mueller CA. Substance use disorder among nurses: a curriculum improvement initiative. Nurse Educ. 2018;43:132–135. doi:10.1097/NNE.0000000000000466 ↩︎

  40. Kameg BN, Lindsay D, Lee H, Mitchell A. Substance use and exposure to adverse childhood experiences in undergraduate and graduate nursing students. J Am Psychiatr Nurses Assoc. 2020;26(4):354–363. doi:10.1177/1078390320905669 ↩︎ ↩︎

  41. Derefinko KJ, Salgado García FI, Talley KM, et al. Adverse childhood experiences predict opioid relapse during treatment among rural adults. Addict Behav. 2019;96:171–174. doi:10.1016/j.addbeh.2019.05.008 ↩︎ ↩︎

  42. Nolan K, Zullo AR, Bosco E, Marchese C, Berard-Collins C. Controlled substance diversion in health systems: a failure modes and effects analysis for prevention. Am J Health Syst Pharm. 2019;76(15):1158–1164. doi:10.1093/ajhp/zxz116 ↩︎ ↩︎

  43. King C, McCue A. Drugs down the drain: when nurses object. Nurs Ethics. 2017;24(4):452–461. doi:10.1177/0969733015614882 ↩︎

  44. Grissinger M. Partially filled vials and syringes in sharps containers are a key source of drug diversion. P T. 2018;43(12):714–717. PMID: 30559580 ↩︎ ↩︎ ↩︎

  45. Bailey C, Jeffs L. Threats to narcotic safety—a narrative review of narcotic incidents, discrepancies and near-misses within a large Canadian health system. Can J Nurs Res. 2022;54(4):440–450. doi:10.1177/08445621211028709 ↩︎ ↩︎

  46. Gao X, Bakshi P, Sunkara Ganti S, et al. Evaluation of an activated carbon-based deactivation system for the disposal of highly abused opioid medications. Drug Dev Ind Pharm. 2018;44(1):125–134. doi:10.1080/03639045.2017.1386199 ↩︎

  47. Ring MT, Pfrimmer DM. Propofol as a drug of diversion: changing disposal practices to reduce risk. Crit Care Nurs. 2021;41(6):45–53. doi:10.4037/ccn2021123 ↩︎ ↩︎

  48. Champion A, Mulholland C. Controlled substance disposal practices of oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2021;79(1):58–63. doi:10.1016/j.joms.2020.08.026 ↩︎

  49. Ranji S. Who will guard the guardians? Preventing drug diversion in hospitals. J Hosp Med. 2019;14(7):451–452. doi:10.12788/jhm.3252 ↩︎

  50. Shah N, Sinha A, Thompson A, Tremper K, Meka A, Kheterpal S. An automated software application reduces controlled substance discrepancies in perioperative areas. Anesthesiology. 2019;131(6):1264–1275. doi:10.1097/ALN.0000000000002957 ↩︎

  51. Derington CG, Lopez BR, Weber RJ, Tubbs CR. Comparison of 3 surveillance methods to detect potential controlled substance diversion in an academic medical center. Hosp Pharm. 2020;55(5):323–331. doi:10.1177/0018578719844170 ↩︎

  52. Draime JA, Anderson DC, Anderson TS. Description and comparison of medication diversion in pharmacies by pharmacists, interns, and pharmacy technicians. J Am Pharm Assoc. 2018;58(3):275–280. doi:10.1016/j.japh.2018.02.009 ↩︎ ↩︎

  53. Knight T, May B, Tyson D, McAuley S, Letzkus P, Enright SM. Detecting drug diversion in health-system data using machine learning and advanced analytics. Am J Health Syst Pharm. 2022;79(16):1345–1354. doi:10.1093/ajhp/zxac035 ↩︎

  54. Toney-Butler TJ, Siela D. Recognizing Alcohol and Drug Impairment in the Workplace in Florida. StatPearls Publishing; 2023. ↩︎

  55. Alroy-Preis S, Daly ER, Adamski C, et al. Large outbreak of Hepatitis C virus associated with drug diversion by a healthcare technician. Clin Infect Dis. 2018;67(6):845–853. doi:10.1093/cid/ciy193 ↩︎

  56. Schuppener LM, Pop-Vicas AE, Brooks EG, et al. Serratia marcescens bacteremia: nosocomial cluster following narcotic diversion. Infect Control Hosp Epidemiol. 2017;38(9):1027–1031. doi:10.1017/ice.2017.137 ↩︎

  57. Njuguna HN, Stinson D, Montgomery P, et al. Hepatitis C virus potentially transmitted by opioid drug diversion from a nurse — Washington, August 2017–March 2018. Morb Mortal Wkly Rep. 2019;68(16):374–376. doi:10.15585/mmwr.mm6816a3 ↩︎

  58. Ross CA, Jakubec SL, Berry NS, Smye V. The business of managing nurses’ substance-use problems. Nurs Inq. 2020;27(1):e12324. doi:10.1111/nin.12324 ↩︎

  59. Strobbe S, Crowley M. Substance use among nurses and nursing students: a joint position statement of the Emergency Nurses Association and the International Nurses Society on Addictions. J Addict Nurs. 2017;28(2):104–106. doi:10.1097/JAN.0000000000000150 ↩︎

  60. Foli KJ, Reddick B, Zhang L, Edwards N. Substance use in registered nurses: where legal, medical and personal collide. J Nurs Regul. 2019;10(2):45–54. doi:10.1016/S2155-8256(19)30115-2 ↩︎

  61. Taylor BG, Lamuda PA, Flanagan E, Watts E, Pollack H, Schneider J. Social stigma toward persons with opioid use disorder: results from a nationally representative survey of U.S. adults. Subst Use Misuse. 2021;56(12):1752–1764. doi:10.1080/10826084.2021.1949611 ↩︎

  62. Mumba M. Employment implications of nurses going through peer assistance programs for substance use disorders. Arch Psychiatr Nurs. 2018;32:561–567. doi:10.1016/j.apnu.2018.03.001 ↩︎

  63. Foli KJ, Zhang L, Reddick B. Predictors of substance use in registered nurses: the role of psychological trauma. West J Nurs Res. 2021;43(11):1023–1033. doi:10.1177/0193945920987123 ↩︎

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