Commonly Diverted Drugs & Regulatory Highlights
Commonly Diverted Drugs
Not surprisingly, especially since they are so prevalent in post-acute and long-term care settings where pain is a significant concern, opioids are among the most commonly diverted drugs. Other prescription medications that are most likely to be diverted include anabolic steroids, central nervous system depressants, psychoactive drugs, and stimulants.
However, this doesn’t mean that there aren’t other drugs that can be diverted. For instance, ondansetron, a medication used to prevent nausea and vomiting, may be sought as a way to manage withdrawal issues. Elsewhere, as Ozempic has gained popularity for weight loss, it presents another possible source of diversion. As Hearn noted, “This drug can cost about $500-$1,000 per month, and it’s not readily available to a lot of people.” It will be important to pay attention to drugs that might fly under the radar because they aren’t controlled substances or highly addictive.
Regulatory Highlights
There is much federal guidance on drug diversion.
Label/Store Drugs and Biologicals CFR(s):
- 483.45(g)(h)(1)(2)483.45(g): Storage of Drugs and Biologicals483.45(h)(1) In accordance with State and Federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys.
- 483.45(h)(2) The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.
The State Operations Manual includes Ftags that relate to both drug handling as well as abuse and neglect. These include:
- F602, F609—Freedom from Abuse, Neglect, Exploitation
- F755—Pharmacy Services: Procedures/Pharmacist/Records
- F761—Pharmacy Services: Labeling and Storage of Drugs and Biologicals[RS1]
Practice Tip
To cite deficient practice at F761, the surveyor’s investigation will generally show that the facility failed to:
- Ensure that all drugs and biologicals used in the facility are labeled in accordance with professional standards, including expiration dates and with appropriate accessory and cautionary instructions; or
- Store all drugs and biologicals in locked compartments, including the storage of schedule II-V medications in separately locked, permanently affixed compartments, permitting only authorized personnel to have access except when the facility uses single unit medication distribution systems in which the quantity stored is minimal and a missing dose can be readily detected; or
- Store medications at proper temperatures and other appropriate environmental controls to preserve their integrity.
CMS recently provided clarification on the phrase "permanently affixed compartment," explaining that “Storing medications safely includes following proper environmental controls, such as refrigeration, in accordance with the drug manufacturer’s specifications. Medications which require refrigeration, such as liquid Ativan, must be stored in a refrigerator which can only be accessed by appropriately authorized staff. A situation where controlled medication(s) requiring refrigeration is stored in a refrigerator that is locked via a separate padlock which is within a locked medication room or in a locked container in the refrigerator in a locked medication room would meet the intent of the long-term care requirements related to medication storage”