The Medicaid Fraud Unit of the Vermont Attorney General's Office recently got into the movie business. No, it is not something made in Hollywood, but it is a movie about a very serious problem that has been present across the United States for many decades. That problem is the diversion of medications by health care workers who are addicted to the medications and steal the drugs from their patients.

Reportedly, the documentary features 4 former addicts, all health care workers, who have cooperated with the Vermont Attorney General's Office in telling their stories, in exchange for more lenient sentences.

In my many years of experience in drug diversion offenses, health facility crimes make me realize the grip that prescription drug addiction can have on a person. Highly trained, compassionate health care employees, who certainly did not go to college so they could abuse pharmaceuticals, become individuals who can be impaired while in a job that may very well require them to make lifeand- death decisions for their patients.

The ultimate crime, however, is that of substitution—removing controlled substances from their package or syringe and replacing them with saline or a substitute tablet, and being apparently oblivious to the level of pain that will undoubtedly be incurred by the innocent patient who receives this tampered product.

When I retired from the Cincinnati Police Department's Pharmaceutical Diversion Squad, my investigators were arresting a health professional about every 6 days; most of those were nurses working in health facilities. Approximately 10% of those arrested were engaged in substitution when they were finally caught. This is not to say that nurses are bad people; they just are the largest number of licensed health professionals in any state, and they have a great exposure to controlled substances.

On the positive side of this story, approximately 60% of those we caught eventually successfully completed rehabilitation. That is a high number when compared with the general public's rate of success, and many of these went on to continue in some form of employment in the health care industry.

One of the major stumbling blocks to addressing this problem has been the reluctance of many health facilities to report these crimes and do something besides fire the workers, sending them on to the next facility with no cure for their addiction.

Perhaps, if strict sanctions were imposed on health facilities whose officals fail to report internal drug diversion, then these businesses would get serious about reporting this crime.

The Vermont Attorney General's Office should be applauded for its efforts in directly trying to deal with this problem through awareness and education. Too many health facilities have kept this a secret for too long, causing needless pain and suffering in patients and tragedy for addicted health professionals, who are not given a choice between rehabilitation and possible incarceration.

Some of our best resources to investigate health facility diversion came from the hospital pharmacy or the pharmacy supplying drugs to the nursing home. Oftentimes, the pharmacist reporting the incident was the key to patient safety and the salvaging of a health care worker's career—or life. I urge you to keep that in mind when coming face-to-face with an obvious diversion in a health facility. You may very well be the difference between a successful outcome and a tragedy.

John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 38-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at burke@choice.net, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.