Caregivers Divert Rxs

Pharmacy Times
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John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 39-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, via the Web site, or by phone at 513-336-0070.

Last month, I discussed the issue of prescription drugs being diverted from legitimate patients without their knowledge and the need for all of us to help in educating these folks on how to safeguard their medications. Some of the more egregious examples of the theft of prescription drugs from legitimate patients are done with their knowledge, however.

The worst case we ever investigated involved an elderly woman who had terminal cancer and was prescribed large amounts of painkillers in an attempt to curb her unrelenting pain. Her grandson and his girlfriend were tending to her on a fairly regular basis, and each time they visited they would steal morphine that was intended for the elder patient.

This went on for some months, as the "caring" duo stole more and more of the opiates until the patient finally found herself without any pain medication at all. Discovered by a neighbor, she was rushed to one of our local hospitals, where she was stabilized on a morphine pump. Two days later, the grandson and his addicted girlfriend visited her at the hospital and, within a few minutes, removed the pump from the patient and wheeled the entire apparatus out of the hospital front door.

Investigators found the abandoned equipment down a steep embankment not far from the hospital with all of the morphine removed. When faced with the detective's questions about the removal of the pump, the patient refused to point the finger at the culprits. Video of the front door revealed, however, that the grandson and his girlfriend were the true perpetrators, and they were promptly arrested.

The patient was well aware that her grandson was stealing drugs from her at home and even more aware that he removed the morphine pump, but because the person involved was her relative, she refused to cooperate with police.

Many other instances of this type of abuse were documented over the years when caregivers were diverting pharmaceuticals to support habits, provide recreational consumption, or sell them on the street. In virtually all of these cases, patients were unwilling to identify the caregiver for fear that they would have no one to provide for their basic needs after the caregiver was arrested.

In another case, a terminally ill woman almost died at the hands of a tending nurse who cared for her at her home. The woman was transported to the hospital by the nurse for a regular procedure in which the nurse participated with other health care professionals. During the procedure, the patient's nurse diverted and injected a massive amount of meperidine (Demerol) into herself. Fortunately, one of the other nurses involved in the procedure noticed the impairment of the first nurse and took over control of the procedure, likely saving the patient's life.

Once this was reported to us, we found evidence of probable diversion of other potent drugs in the patient's home. On a day when the offending nurse was not working, we approached the patient and her husband about cooperating in the investigation. Our goal was to place a couple of cameras with their consent and to catch the nurse in the act. After explaining what was taking place, we were politely asked to leave by the husband, who either refused to believe the facts or did not want to face the reality of taking care of his ailing wife if the nurse was removed from the home. Since our evidence was not as conclusive as we would have liked, we had to discontinue the investigation.

These types of incidents, where victims were aware they were being exploited, have been rare. It is much more likely that victims of this kind of diversion have no clue that a caregiver, relative, or home worker is stealing their medication. Providing them with commonsense advice on securing and properly disposing of the drugs when no longer being used might avoid a real-life tragedy

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