Last Updated on: 17th October 2023, 10:57 pm

Responding to Drug Diversion and Opioid Investigations: A Guide for Pharmacists

Hey there fellow pharmacists! Dealing with drug diversion and opioid investigations can be scary and stressful. As healthcare providers, we want to do the right thing and follow the rules – but sometimes the rules seem unclear, or the investigators seem intimidating. I totally get it! I’ve been there too. But don’t worry, we’ll get through this together. I wrote this article to help explain what to expect, and how to handle drug diversion and opioid investigations smoothly. Let’s break it down step-by-step so you feel prepared.

What is Drug Diversion?

Drug diversion is when prescription drugs are transferred from their intended legal purpose into illegal hands or uses. Some examples are:

• Someone steals drugs from a pharmacy
• A patient forges prescriptions
• A doctor writes unnecessary prescriptions
• Someone sells their own prescription drugs to others

Opioid painkillers like oxycodone are commonly diverted drugs. When this happens, the diverted drugs can be misused, causing addiction and overdoses. So drug diversion is taken very seriously by law enforcement and healthcare regulators.

How Do Investigations Start?

Investigators usually start looking into a pharmacy or pharmacist when data analysis shows potential “red flags” for diversion. Some common red flags are:

• High volume of controlled substances dispensed
• High number of prescriptions for commonly diverted drugs like oxycodone
• Prescriptions written by doctors who are known sources of diverted drugs
• Patients who fill controlled substance prescriptions at multiple pharmacies

If investigators see these patterns, they may open a case to dig deeper. The goal is to determine if diversion is happening, and if the pharmacy or pharmacist was knowingly enabling it.

What Should I Expect During the Investigation?

The investigators will collect information to build their case. Here are some things you may be asked to provide or expect:

• Records of dispensing controlled substances
• Internal pharmacy policies and procedures
• Patient profiles in your dispensing system
• Interviews with you or pharmacy staff
• Surveillance or undercover operations

They will review all this information to determine if diversion occurred, and if you as the pharmacist should have detected and prevented it. If they find significant problems, you could face disciplinary actions like license suspension or revocation.

How Should I Handle the Investigation Process?

I know it’s intimidating, but the best thing is to stay calm and cooperative. Getting defensive or uncooperative will just escalate tensions. Here are some tips:

• Be polite and professional with investigators at all times.
• Respond promptly to any requests for records or interviews.
• If asked for an interview, request to have your lawyer present.
• Provide records in a well-organized manner.
• Never destroy or alter any records.
• Don’t try to cover up any potential issues – be transparent.

Basically, you want to demonstrate that you have nothing to hide and are willing to help get to the bottom of the situation. That gives you the high ground!

How Can I Prevent Drug Diversion?

The best defense is a good offense, as they say. Here are some proactive ways you can prevent and detect diversion:

• Follow your state’s prescription monitoring program (PMP) requirements – check patient histories!
• Verify the prescriber’s DEA registration and state license.
• Watch for “doctor shopping” patients getting multiple scripts.
• Check IDs carefully and keep copies.
• Monitor inventory closely and investigate any unexplained losses.
• Train staff on diversion risks and how to spot red flags.
• Consider security upgrades like cameras or prescription drop boxes.

Documenting that you have solid policies and procedures in place goes a long way if you ever end up under investigation.

What Legal Protections Do I Have?

There are a few laws that give pharmacists some cover in ambiguous situations:

• The Controlled Substances Act allows you to refuse to fill any prescription you deem inappropriate. You can lean on this law to defend declining to fill scripts that seem questionable.
• Most states have laws or policies that do not require pharmacists to fill prescriptions they suspect could lead to harm. This helps protect you if you refuse a sketchy prescription.
• The Ensuring Patient Access and Effective Drug Enforcement Act clarified that pharmacists need to check state prescription drug monitoring programs before dispensing controlled substances. Documenting your compliance shows you are trying to prevent diversion.

Relying on these laws and policies can help shield you from accusations of enabling diversion. Make sure to document any refused scripts or PMP checks!

What If I Do Get Disciplined?

Hopefully following the best practices above will keep you off the radar of investigators. But if you do end up getting disciplined, here are some options:

• Appeal the decision – You may be able to appeal to an administrative law court or board of pharmacy and get the discipline reduced or reversed.
• Negotiate a settlement – Offer to accept lighter discipline or remedial education in exchange for dropping an appeal.
• Enroll in a pharmacist recovery program – Self-enrolling in a program to address knowledge gaps or stress can show you are committed to improvement.

Don’t panic if you receive discipline – it’s not necessarily the end of your career. Take responsibility and demonstrate you are addressing any problem areas.

The Key is Being Prepared and Proactive

Whew, that was a lot of information! The main takeaways are:

• Understand what drug diversion is and why it is investigated.
• Cooperate fully if you find yourself under investigation.
• Implement policies to prevent diversion in your pharmacy.
• Know your legal protections as a pharmacist.
• Respond constructively if disciplined.

Preparation is power when it comes to drug diversion and opioid investigations. So read up on the laws and best practices so you’re ready. And reach out to colleagues who have dealt with this before – we’re stronger when we support each other. You’ve got this!

Let me know in the comments if you have any other questions. I’m always happy to help fellow pharmacists understand this complicated stuff. We’re all in this together.