Tech Talk: Preventing Drug Diversion

Up to one in seven healthcare professionals will suffer from a substance abuse disorder.2 Diversion of controlled substances from hospital settings may play a role supplying these individuals with substances they’re abusing. We don’t know the extent of this diversion, but information is coming to light about prevention.1,2 Tightening up diversion opportunities in your practice setting is a key to minimizing internal theft, and keeping patients and hospital staff safe.1,2 The fact that pharmacy techs have a front row seat in terms of understanding processes involving controlled substances can make you a valuable resource for providing feedback for closing loopholes that may otherwise go unrecognized.

Use this tool to talk with your pharmacy colleagues about ways to safeguard against drug diversion in your hospital. These discussions will help raise awareness and may prevent future problems. Share the information with your medication safety officer, manager, or supervisor.


Your Feedback

What’s your practice setting?





Primary work area(s):


Primary duties:



In what situations do you work with controlled substances? Which controlled substances do you routinely work with?

For example: If you deliver meds to automated dispensing cabinets, it’s likely to involve controlled substances such as oxycodone tablets. Or, if you’re involved in sterile compounding, you may prep compounds with controlled substances, such as bupivacaine/fentanyl epidural infusions.



What policies or procedures are in place to help prevent diversion in these situations?


For example: A double check by a pharmacist may be required when controlled substances are removed from stock for the purpose of filling an automated dispensing cabinet.


What additional precautions do you take to help prevent diversion of controlled substances?


For example: If you deliver controlled substances to an automated dispensing cabinet, you avoid leaving your cart unattended at any time.



Have you recently seen any red flags that may have indicated that drug diversion was taking place?


For example: If you notice multiple discrepancies in a cabinet involving a particular controlled substance, this may indicate diversion. Or, if you find tablets missing from cards or strips, or vials that have had their caps removed and replaced, this may indicate diversion.



If you noticed a red flag for drug diversion, how did you do it? Were required precautions being taken, or were they skipped? What did you do when you noticed this red flag?


For example: Taking the time to carefully inspect meds when restocking controlled substances in cabinets may help you identify any tampering.



How could potential drug diversion have been avoided in the examples you’ve given, or in other scenarios where drug diversion has occurred?



What additional comments, feedback, or thoughts do you have on this important topic?


Project Leader in preparation of this clinical resource (351024): Stacy A. Hester, R.Ph., BCPS, Associate Editor


  1. Nolan K, Zullo AR, Bosco E, et al. Controlled substance diversion in health systems: A failure modes and effects analysis for prevention. Am J Health Syst Pharm 2019;76:1158-64.
  2. Brummond PW, Chen DF, Churchill WW, et al. ASHP guidelines on preventing diversion of controlled substances. Am J Health Syst Pharm 2017;74:325-48.


  3. Cite this document as follows: Clinical Resource, Tech Talk: Preventing Drug Diversion. Pharmacist’s Letter/Prescriber’s Letter. October 2019.

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