What’s Missing from the Opioid Conversation in Canada? Healthcare Workers
Statistics Canada recently revealed that in 2017, for the first time in 40 years, life expectancy in Canada saw no increase. The agency attributes this change to the impact of the opioid crisis and prevalence of accidental drug poisonings (Statistics Canada, 2017).
Canadian healthcare workers provide care at the frontlines of the opioid crisis (Weeks, 2019). Often left out of conversations about the opioid issue are the hospital workers who care for those affected by opioid misuse and face personal risks in the workplace for developing substance abuse disorders themselves, specifically those related to drug diversion.
Drug diversion refers to the transfer of medications from legitimate, medical use to non-medical use, including personal substance abuse or drug trafficking. Research shows that daily unsupervised access to controlled substances and a stressful work environment are significant risk factors for developing a substance abuse disorder and have significantly contributed to job-related mortality for some healthcare professionals; i.e. anesthesiology or nursing. (Trinkoff et. al., 2000) (Warner et. al., 2015) (Pilgrim et. al. 2017).
Estimates indicate approximately one in every 10 healthcare professionals struggle with addiction or abusing drugs not prescribed for their personal use (Coop, 2009) (Thomas & Siele, 2011).
Drug diversion in hospitals has dire and broad implications. Diversion by caregivers often involves self-administration of all or part of a dose intended for patients. Consequences include patients receiving less than full doses of medication, caregivers working in an impaired state and infection outbreaks from contaminated needles. Without effective solutions to stop diversion, hospital workers and those under their care will continue to be at risk.
As a health services researcher, I am glad to see national policy makers prioritizing the opioid issue and efforts to prevent further harm to Canadians. Announcedthis summer, measures show that Governments are allotting funds, policy makers are speaking up and strategies are being put in place to combat opioid overdoses (Pilgrim et. al. 2017).
Practice leaders and researchers are also reviewing current hospital systems to better understand systemic gaps to combat vulnerabilities across the medication-use process. Vulnerabilities can exist at any stage, from procurement to preparation to waste removal (Warner et. al., 2015). There are points at which healthcare workers can divert medication to illegitimate use while treatments are enroute to patients. A recent literature review by a group of Ontario researchers sheds light on known evidence-based safeguards, including adding security measures to the physical storage of treatments in hospitals, or improving inventory systems to identify if the correct amount of treatment is reaching patients or being diverted along the way (Fan et. al., 2019).
In March 2019, as part of its commitment in the Joint Statement of Action to Address the Opioid Crisis, the Canadian Society for Hospital Pharmacists (CSHP) released the first guidelines on secured controlled substances management and diversion prevention. The CSHP recommends that inventory management processes be part of a linked system that allows controlled substances to be easily tracked as they move through the facility, and advocates for the continuous review of measurable and objective key performance indicators to prevent and detect diversion (Canadian Society for Hospital Pharmacists, 2019).
Even still, we have work to do to prevent drug diversion and protect healthcare workers.
Without focused attention and resources to adopt these best practices, health systems will continue to struggle with addressing gaps. We need ongoing research, supported by Canada’s healthcare system and its regulators, to continue understanding and preventing points of diversion. We must develop system-based strategies and share best practices. On September 23, 2019 practice leaders, researchers, regulators and policy-makers convened for an inaugural summit to come together to share best practices and discuss how they can work together to proactively address drug diversion in Canadian hospitals.
No one individual is accountable for any diversion event. It is a systemic issue requiring the collaboration of all stakeholders. We are all accountable.
When announcing the new government investment in combatting the opioid crisis, then Health Minister Ginette Petitpas Taylor said, “Harm reduction means treating substance use not as a moral failure but rather as a medical one. While some might see harm reduction as controversial, I see it as truly essential (The Canadian Press, 2019).”
As then Minister Petitpas Taylor rightfully indicated, it is the medical system, not the individual alone, who bears the responsibility for reducing harm. Healthcare workers are our system’s greatest asset. We owe it to them to improve the system they work in every day. For the sake of patients, hospital workers and the healthcare system, we in healthcare services research, along with allies in hospital management and policy development, have a responsibility to continue investigating and implementing stronger controls to protect all Canadians.
Canadian Society for Hospital Pharmacists. 2019. “Controlled Drugs and Substances in Hospitals and Healthcare Facilities: Guidelines on Secure Management and Diversion Prevention”.
About the Author
Eva Baginska, Vice President, Health Economics & Outcomes Research, BD - Canada
Copp, M.A.B. 2009. “Drug addiction among nurses: Confronting a quiet epidemic”. Modern Medicine Network. 1.
Fan, M., D. Tscheng, M. Hamilton, B. Hyland, R. Reding, and P. Trbovich. 2019. “Diversion of Controlled Drugs in Hospitals: A Scoping Review of Contributors and Safeguards”. Journal of Hospital Medicine. Published online first 2019 Jun 12.
Pilgrim, J.L., R. Dorward, and O.H. Drummer. 2017. “Drug?caused deaths in Australian medical practitioners and health?care professionals”. Addiction. 112(3):486-93.
Statistics Canada. 2019. “Changes in life expectancy by selected causes of death, 2017”.
The Canadian Press. 2019. “Federal government adds millions for ‘essential’ harm reduction in opioid crisis”. The Globe and Mail.
Thomas, C., and D. Siela. 2011. “The impaired nurse: Would you know what to do if you suspected substance abuse”. American Nurse Today. 6(8):1-9.
Trinkoff, A.M., Q. Zhou, C. L. Storr, K.L. Soeken. 2000. “Workplace access, negative prescriptions, job strain, and substance use in registered nurses”. Nursing Research. 49(2):83-90.
Warner, D.O., K. Berge, H. Sun, A. Harman, A. Hanson, D. R. Schroeder. 2015. “Risk and Outcomes of Substance Use Disorder among Anesthesiology Residents A Matched Cohort Analysis”. Anesthesiology: The Journal of the American Society of Anesthesiologists. 123(4):929-36.
Weeks, C., 2019. “One person died every two hours of opioid-related overdose in Canada last year, report says”. The Globe and Mail.
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