The Top 5 Ways Drugs Are Diverted in Hospitals—and How to Monitor Them

Drug diversion in healthcare settings, especially hospitals, is a critical concern that threatens patient safety, disrupts operations, and jeopardizes professional licensure. Controlled substances like opioids are the most frequently diverted, but any medication with abuse potential can be at risk. Understanding the most common diversion methods is essential for creating effective prevention strategies. Here are five of the most prevalent methods of diversion—and how hospitals can monitor and reduce their occurrence.

1. Falsifying Medication Administration Records (MARs)
One of the most common methods of diversion involves healthcare professionals documenting that a medication was administered to a patient when it was not. This is especially easy in chaotic or understaffed settings where oversight is minimal.
How to monitor it:Use electronic MARs integrated with automated dispensing cabinets (ADCs) to flag discrepancies.
Conduct regular audits comparing documented administrations with patient outcomes and pain scores.
Implement random observational spot-checks of administration practices.

2. “Wasting” Unused Medication
When a partial dose of a controlled substance is administered, the remaining medication should be properly discarded in the presence of a witness. However, individuals may fake or manipulate this step, keeping the unused portion for personal use.
How to monitor it:Require two-user electronic verification for waste documentation.
Regularly review waste logs and investigate patterns of frequent partial dosing.
Use tamper-evident waste containers and ensure proper witnessing procedures are followed.

3. Tampering with Patient Medications
Some individuals may substitute saline or another non-controlled substance in place of the actual drug to avoid detection, leaving the patient under-medicated—or worse, untreated.
How to monitor it:Implement strict chain-of-custody protocols for high-risk medications.
Train staff to recognize signs of medication tampering or changes in drug effectiveness.
Monitor patient outcomes and investigate unexpected pain or sedation issues.

4. Illegitimate Use of Automated Dispensing Machines (ADMs)
ADMs like Pyxis or Omnicell are designed to improve safety and tracking, but they can be overridden or accessed with borrowed or stolen credentials to divert drugs.
How to monitor it:Limit and tightly control override access.
Enable real-time alerts for suspicious dispensing patterns or frequent overrides.
Perform regular audits of ADM access logs and cross-reference them with patient charts.

5. Theft from Pharmacy Stock or Deliveries
Diversion can also occur at the pharmacy level, whether from internal stock, incoming shipments, or even expired or discarded medications.
How to monitor it:Use perpetual inventory systems with tight reconciliation processes.
Conduct regular cycle counts and compare them to usage records.
Monitor security camera footage and restrict access to high-risk storage areas.

Final Thoughts
Preventing drug diversion requires a comprehensive approach that includes technology, training, oversight, and a culture that encourages transparency and accountability. By understanding the most common diversion tactics and implementing strong monitoring systems, hospitals can protect their patients, support ethical practice, and maintain regulatory compliance.