Imagine you are injured in a car accident and go to the hospital. There, you’ll get pain medication prescribed by your doctor…unless you don’t.
Unfortunately, too many patients are not prescribed the drug because healthcare professionals – a distinct minority but not many – “divert” the drug for other uses, often abusing the drug itself. According to the U.S. Substance Abuse and Mental Health Services Administration and the American Nurses Association, an estimated 10 percent of health care workers abuse drugs.
Drug diversions of this magnitude cause great distress to affected patients, who may be taking other drugs illegally to cover up the behavior. However, the harm is far more than one patient. Any patient will find themselves at the mercy of compromised clinicians. There are also risks to third-party recipients of stolen drugs, some of which can be fatal.
Vendors diverting prescription drugs could cost hospital systems millions of dollars in fines for flawed medication management processes. If the public finds out that a doctor or nurse is stealing a patient’s medication, it can also damage the reputation.
At risk are hospitals, health care systems, pharmacies, clinics, nursing homes and emergency centers. Each has multiple easily diverted drug lifecycle processes, including wholesaler procurement and delivery, central pharmacy inventory management, pharmacy distribution, dispensing to doctors and nurses, and finally patient management.
The problem of drug diversion has been around since Hippocrates, but it is especially acute now.U.S. drug overdose deaths All-time high in 2020 and still on the rise, while the Covid-19 pandemic has put pressure on already-stretched health care workers. Crowded ICU environments couldn’t be more demanding, making transferring medications easier than ever.
Healthcare administrators need support
Hospitals and healthcare systems have been grappling with this problem, creating busy oversight committees and cumbersome processes. On paper and in a rudimentary computing system, they try to follow every prescription from the pharmacy to the patient (and back to the pharmacy if there is an excess to process).
The work is so complex, and the perpetrator so elusive, that detection is beyond what humans can handle. Combating drug diversion is a job better suited to the advanced analytics and machine learning that many healthcare systems are adopting. A well-designed system is able to understand normal drug flow and detect anomalies throughout a large organization while minimizing false positives.
Of course, the technical challenges are enormous. Abnormalities in prescription drug flow are only meaningful when compared to valid pictures of normal use. If a hospital has only three years of historical medication data, and two of those are severely impacted by the pandemic, what is the true baseline? The answer is that no one knows.
Changing pharmacy information systems, automated dispensing systems, and electronic health record systems increase the difficulty of synthesizing useful data. The same goes for different labels used by different technology vendors for different data, such as brand-name drugs and their generics.
Another challenge is that machine-learning systems require regular human attention to do their job: someone needs to tell the system whether its latest alerts are accurate—determined whether an employee is actually diverting prescription drugs—or a false one. This is one way machine learning gets smarter. By ignoring this step, you are wasting time and money.
Finally, there is the challenge of keeping data up-to-date. Few drug diversion detection systems bring real-world, instantaneous data streams of drug flow back into the system in near real-time. But that’s exactly what it takes to perfect the baseline.
Done right, drug diversion prevention powered by advanced computing can save lives, improve patient care, reduce healthcare costs, and eliminate wasted effort.
It’s important work, and it’s satisfying. For me, the payoff is not shaming someone with substance use disorder. This is to protect patients, healthcare workers, hospital systems and public health – making life easier for everyone involved.
Photo: cagkansayin, Getty Images
