Columnist Norris Cunnigham discusses infection control penalties.

Q: It seems as if drug diversions in nursing homes increased during the pandemic. Is this accurate? 

A: Simply put, it’s difficult to determine if there was actually an increase in drug diversions. The myriad problems facing long-term care facilities — including resource depletion, isolation, staffing shortages and the constant emotional fallout tied to COVID-related illness and death — contributed to increased substance use disorder for clinicians, mainly nurses, in our skilled nursing facilities. 

While the data shows substance use disorder is on the rise, reports suggest the pandemic negatively impacted the availability of credible data on the issue. According to Protenus, a healthcare technology organization specializing in risk-reduction solutions, the true scope of drug diversion in 2020 may have been concealed by COVID-19. The 2021 Protenus Diversion Digest reported that “health organizations’ defenses against drug diversion were jeopardized in 2020.”

An analysis of 2020 data identified a significant lack of reported incidents of drug diversion in 18 states and the District of Columbia compared to previous years.

“A complete lack of reported incidents in more than one-third of states in 2020 indicates that an alarming amount of drug diversion is going undetected,” it found. “Given that the pandemic placed tremendous stress on healthcare professionals, and stress is a known contributor to drug misuse, it is possible that diversion did not decrease but rather appeared muted due to under-reporting.”

We know that long-term care residents face greater risk of becoming victims of drug diversion. This places increased onus on operators to adopt and implement protocols focused on aggressive oversight of controlled substances.

They must also address the pressures that can lead staff to fall victim to substance use disorder and divert drugs.