Investigating the causes of Canada’s drug diversion crisis

In this article, I present a firsthand account as an anaesthetist with substance use disorder who has been through rehabilitation and returned to clinical anaesthesia, followed by an overview of substance use disorder in anaesthesia. Substance use disorder is prevalent within the anaesthesia community and can result in tragic consequences, including death in many cases. The incidence is around one to two per 1000 anaesthetist years and this appears to be rising, perhaps mirroring the population-wide increase in substance use disorder as a result of the opioid epidemic. Recognising substance use disorder in a colleague and intervening to try and help them and protect patients can be immensely challenging. Carrying out a successful intervention requires careful planning and coordination in order to protect the affected individual, their colleagues and patients. Returning to clinical anaesthesia following a diagnosis of substance use disorder is also contentious, with the high abstinence rate (relative to the wider substance use disorder population) having to be balanced against the risk of death following relapse. Any return to practice must be well planned and supported, and include appropriate toxicology screening. With such measures, rehabilitation and a return to clinical anaesthesia is possible in certain cases. For the affected individual regaining, then maintaining, their professional identity can be a powerful motivator to remain abstinent. Drug diversion and substance use disorder in anaesthesia is unlikely ever to be fully preventable, but strategies such as biometric dispensing, analysis of unused drugs, random toxicology and ongoing education may help to keep it to a minimum.

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Risks of controlled substance drug diversion

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab038 ◽

2021 ◽

Author(s):

Teresa K Ash ◽

Gina Murray ◽

Rebekah V Hiler

Keyword(s):

Drug Diversion ◽

Controlled Substance

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Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk

Critical Care Nurse ◽

10.4037/ccn2021123 ◽

2021 ◽

Vol 41 (6) ◽

pp. 45-53

Author(s):

Michael T. Ring ◽

Dale M. Pfrimmer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Activated Carbon ◽

Health Care Professionals ◽

Ecological Impact ◽

High Volume ◽

Operating Rooms ◽

Ease Of Use ◽

Control Mechanisms ◽

Drug Diversion

Background Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods. Local Problem Objectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol’s potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact. Methods The intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses’ workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention. Results Survey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward. Conclusion Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.

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