Drug Diversion and Abuse: Nighttime Drug Diversion

Pharmacy Times, March 2015 Central Nervous System, Volume 81, Issue 3

The places affected by nighttime diversion are emergency departments and 24-hour and late-night pharmacies.

A topic I haven’t covered in a very long time is the activity of drug seekers at night and after the close of most businesses, including doctors’ offices and clinics. The places affected by nighttime diversion are emergency departments (EDs) and 24-hour and late-night pharmacies.

Drug seekers have been presenting to America’s EDs for decades, and this activity hasn’t decreased much, if at all. The supposed injuries and problems for which drug seekers come to the ED are as varied as prescription drug seekers themselves. I’ve seen cases of people who in order to receive a pain shot burned parts of their bodies, including their testicles; aggravated existing root canal work in the ED parking lot; and carried their own blood in syringes to feign vomiting it.

Many hospitals will not tell callers which physicians are on duty in the ED, as drug seekers want to know when liberal prescribers are working. In small communities, drug seekers may check the hospital parking lot to find out which physician’s car is present.

ED personnel are constantly under scrutiny by hospital administration as patient satisfaction is monitored. If enough complaints are logged against a certain prescriber, he is in jeopardy of losing his job. Some prescribers succumb to this pressure, doing whatever it takes to keep patients happy.

Some hospitals recognize that having drug seekers in their ED is not good for anyone, especially legitimate patients, whose face time with doctors can be reduced because of drug seekers. Doctors and other staff at these hospital may report drug-seeking behavior and liberally query the prescription monitoring program of their state to help root out violators. I am not sure that ED staff members like this are in the majority, but I think their number is growing due to frustration.

The other unfortunate players in nighttime diversion are 24-hour and late-night pharmacies. Every urban community has 1 or more 24-hour pharmacies, many of which are near hospitals to allow legitimate patients to conveniently fill their prescriptions. However, these pharmacies are also a convenient target for latenight prescription drug seekers.

Nighttime pharmacists are well aware of the regular folks who frequent city EDs and bring in their prescriptions for filling. The prescriptions are generally for small doses, which highlights the fact that these addicts are willing to do horrible things to their bodies for a few pills. They must repeat this process night after night, and it may expand into attempts to deceive daytime doctors at their offices and clinics.

Over the years, I have developed great respect for those who work in EDs, especially at night. They must deal with drug seekers and legitimate patients—and try to ascertain the difference between them—while producing a minimum number of patient complaints and minimizing the waiting period!

Pharmacists and technicians who work the night shift are hoping and praying that they don’t get robbed. They try to determine whether a prescription presented at 2:00 am is a scam or was actually written the day before for the patient—and without the ability to verify the prescription at this time of night.

I don’t see the phenomenon of nighttime diversion stopping anytime soon, but I do admire those working in affected EDs and pharmacies and their attempt to deliver quality health care. I offer kudos to all of you affected by nighttime diversion, and thanks for being there for legitimate patients who often desperately need your help.

Cmdr Burke is a 40-year veteran of law enforcement and the past president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@rxdiversion.com or via the website www.rxdiversion.com.