Anesthesia and Surgery-Related Drug Diversion

Anesthesiologists are managing addictive substances daily in the operating room (5). Exposure to these substances, whether as patient or clinician, comes with significant risk given the potent effects of some of them. As a result, drug diversion related to anesthesia and surgery remains a problem. Despite decades of efforts at increasing education and prevention, drug diversion among anesthesia professionals is a too-common occurrence (5). Prescription opioid diversion and misuse also occur at high rates among patients who have undergone surgery (4). With continuing incidences of anesthesia –and surgery-related drug diversion amongst both healthcare workers and patients, new interventions are called for to reduce the rates of misuse, diversion, and deaths related to substance abuse.

Drug diversion refers to the unauthorized use or distribution of prescription drugs for purposes outside of which they were prescribed. Opioids like fentanyl and sufentanil, which are used for pain management in the OR, are some of the most common controlled substances that patients and providers divert. In a sample of 966 adults in the United States who had recently undergone surgery, one in three reported misusing prescribed opioids, and one in five admitted to diverting prescription opioids (4). The risk of misuse or diversion was found to be higher for patients who worked in healthcare, refilled opioid prescriptions, and held on to leftover pills (4). The type of medications used in anesthesia and surgery make those fields particular important for assessing and preventing drug diversion.

Similarly, addiction is a significant issue in the anesthesia workplace (2). The prevalence of drug abuse among anesthesiologists is related to their proximity to large quantities of addictive drugs, the high-stress working environment, and exposure to drugs in the workplace, which sensitizes the brain’s reward pathways and makes anesthesia professionals more vulnerable to substance abuse (2). A study from 1991-2001 found that 80% of anesthesia residency programs had at least one incidence of drug diversion, and 19% had at least one mortality related to substance abuse (5). Patients whose anesthetic drugs are diverted can suffer from undertreatment of their pain (3).

Incidences of drug diversion related to surgery and anesthesia seem to persist despite increased implementation of education and surveillance (3). Anesthesia departments with more education programs have not necessarily seen lower rates of drug diversion (5). Some experts argue that the only effective way to reduce drug diversion among anesthesiology professionals is to bar anesthesiologists from freely obtaining and prescribing opioids (6). Electronic screening, machine learning algorithms that predict incidences of diversion, and random drug testing are other possible solutions being explored (5).

Providers can also reduce incidences of drug diversion among surgery patients by prescribing responsibly and taking an active role in the proper disposal of leftover pills (4). Efforts to improve proper disposal of unused pills, such as installing a dropbox, giving patients activated charcoal bags, or offering a buyback program, may mitigate surgery-associated opioid misuse and diversion (4).

References

1. Ades, Joshua, et al. “Nurse Anesthesia Diversion Prevention: A Knowledge and Needs Gap Analysis.” Workplace Health & Safety, 2023, vol. 71, no. 2, pp. 50-56. Doi: 10.1177/21650799221119153

2. Bryson, Ethan O., et al. “Addiction and Substance Abuse in Anesthesiology.” Anesthesiology, 2008, no. 109, pp. 905–917. doi: 10.1097/ALN.0b013e3181895bc1

3. Fitzsimons, Michael G et al. “Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review.” Brazilian Journal of Anesthesiology (Elsevier), vol. 73, no. 6, 2023, pp. 810-818. doi:10.1016/j.bjane.2023.07.008

4. Porter, Eleah D., et al. “Surgery Prescription Opioid Misuse and Diversion in US Adults and Associated Risk Factors.” Journal of Surgical Research, vol. 275, 2022, pp. 208-217, doi: 10.1016/j.jss.2022.01.030

5. Tetzlaff, John E. “Drug Diversion, Chemical Dependence, and Anesthesiology.” Advances in Anesthesia, vol. 29, no. 1, 2011, pp. 113-127, doi: 10.1016/j.aan.2011.07.004

6. Van Pelt, Maria, et al. “Drug Diversion in the Anesthesia Profession: How Can the Anesthesia Patient Safety Foundation Help Everyone Be Safe?” Anesthesia and Analgesia, Oct 30 2018. Doi: 10.1213/ANE.0000000000003878