ASHP 2023: Peer survey results on combatting drug diversion

Amy Koczera

Drug diversion continues to be one of the biggest challenges facing health system pharmacy professionals and IT security teams. Our recent survey of ASHP 2023 attendees reveals what they’re doing, not doing, and planning to do to combat this problem with widespread repercussions. 

The ASHP Midyear Clinical Meeting and Exhibition is always an exciting time for us to learn about the new trends and innovations in pharmacy technology. At the December 2023 meeting, we heard pharmacy professionals discuss some of the biggest challenges they face today – including drug diversion, one of the most persistent and difficult to overcome.

To gather insight into current drug diversion monitoring programs and practices, Imprivata ran a survey at our booth during the event. We asked 49 attendees about their monitoring capabilities and challenges with detecting drug diversion.

The results led us to this core takeaway: organizations lack a consistent approach to monitoring for drug diversion. In addition, addressing drug diversion on all levels requires continued innovation. Let’s dive into the survey findings to explore these challenges.

Evolving reporting requirements

Over the last 10 years, regulations around prescribing controlled substances have become stricter. The DEA requires organizations to implement electronic prescribing of controlled substances (EPCS), as well as to report cases of internal drug diversion. These requirements are driving organizations to adopt more robust programs for drug diversion. More than half of those surveyed (55%) currently have a drug diversion management program in place.

  • 55% of respondents currently have a drug diversion management program
    • 29.6% implemented a program following a drug diversion incident
    • 66.7% implemented a program due to regulatory requirements

Two thirds of respondents (66.7%) said they adopted a program due to regulatory requirements, and nearly one third (29.6%) said a drug diversion incident led them to adopt a program.

Meeting compliance needs

To demonstrate compliance with DEA requirements, healthcare organizations can take a variety of approaches to detecting and reporting. Our survey found that respondents have adopted the following approaches:

  • 76.9% have a drug diversion committee dedicated to building a diversion monitoring program
  • 46.2% have adopted a drug diversion education program
  • 50% have a proactive, automated monitoring tool for identifying diversion anomalies
  • 38.5% rely primarily on manual and reactive monitoring by cross-referencing manual reports for suspicious activity

An automated drug diversion intelligence solution that leverages AI and machine learning can help organizations detect and remediate drug diversion swiftly and securely, while also streamlining reporting. On the other hand, manual and reactive processes can be less effective, not to mention time-consuming and fraught with error.

Competing priorities

As cyberattacks inundate the healthcare sector, IT and security spending have remained a top priority in recent years. In fact, more than 85% of health systems are increasing their digital and IT budgets in 2024, according to a Guidehouse report. However, even with increased resources and budget, allocating those efforts and funds toward a drug diversion management program is not an immediate priority, though it may be part of a long-term plan. Of the ASHP respondents who reported not having a drug diversion management program:

  • 36% said they have plans to implement a program over the next 12 months
  • Those that don’t have plans to adopt a program cited resource constraints (35.7%) or budgetary constraints (14.3%) as the main reasons

Assessing digital identity maturity

An organization’s digital identity maturity can also impact its ability to monitor for drug diversion accurately and efficiently. However, not all healthcare organizations have a broader integration or digitally mature infrastructure. What’s more, not all prescribing activities are documented electronically. Our survey found that:

  • Over half of respondents (55.6%) said that information from their automated dispensing cabinets is integrated across the entire health system
  • 25.9% of respondents reported that this information is audited by individual departments or hospitals, but not across the entire system
  • 7.4% of respondents reported that some medications are documented electronically but not all This lack of integration between prescribing cabinets and information across the health system can create challenges and make diversion harder to detect, especially for those relying on manual auditing and reporting processes.

Innovating drug diversion monitoring technologies

Automated monitoring technologies that leverage AI and machine learning like Imprivata digital identity intelligence enable organizations to quickly discover risks of diversion, decrease false positives, and streamline compliance. Nonetheless, there’s always room for greater innovation and improvement. For those using a proactive monitoring tool, we asked which features respondents would prefer to add:

  • 44% lifecycle auditing capabilities
  • 48% monitoring of anesthesia pumps
  • 32% auditing of wholesaler data
  • 52% IV pump integration
  • 44% PCA smart pump integration

It’s important to consider how innovation in existing technologies can improve drug diversion detection, especially since 65% of healthcare workers believe most drug diversion goes undetected. Lifecycle auditing, monitoring of anesthesia pumps, auditing of wholesaler data, IV pump integration, and PCA smart pump integration are all areas where innovation can enhance the effectiveness of drug diversion prevention programs. By leveraging advanced, integrated solutions and implementing a drug diversion monitoring program, healthcare organizations can effectively combat drug diversion, protect patient safety, and ensure compliance with regulatory requirements.

For additional insight on combatting drug diversion, see our brief video.