Controlled Substance Accountability

I’ve had the opportunity to work at over 50+ different healthcare facilities.  I’ve had the unfortunate opportunity to deal with my fair share of diversion and potential diversion cases.  It’s not fun.  Drug diversion can get complex, but there are two very simple principles to start with that can get you thinking about how to minimize controlled substance diversion in your facility.

1.  Limited access.  Who has access to drugs at your facility?  I’m not simply talking about policy.  I’m talking in actual terms.  Who is able to get into your medication room, medication cart etc.  Did you let the maintenance guy in the med room and walked away for a half hour?  Did you leave a medication cart unlocked for a period of time?  Is the key to the narc cupboard in your desk where no one is “supposed” to know where it is, but everyone does? – Limited access means limited all the time.  If there are obvious holes in your system, fix it.

2.  Counting medications.  This allows you to minimize the time on any potential investigation if a loss or theft occurs.  If you count controlled medications every shift, that really limits the timeframe you have to investigate (or at least it should).  When I say counting medications, I actually mean it, not being lazy or too busy and saying it looks close enough.  It is your license on the line.  Take the flipside of this situation – that PRN Norco that hasn’t been used in months and no one is counting it sitting in the unlocked cupboard or med cart.  If that turns up missing, would you catch it?  If someone did notice it was gone, how many different staff have had access to that over a period of months? Counting is time consuming, but so is investigating a potential theft or loss.

Here’s just a couple of simple points to help get you thinking about this significant problem.  If this post doesn’t pertain to you because your healthcare facility has never had a problem with diversion, you can contact me at the email on this website, because you’ll probably be the next one to have an issue.


  1. Patricia Poczciwinski

    Thanks for the info Eric!

  2. Bob Coolidge

    How do I contact you?
    I do drug diversion investigations and controlled substance registrations.

    • Eric Christianson

      I sent you an email, thanks for reaching out! – Eric

  3. Aimee Baillie

    Any recoomendations/suggestions on how long term care facilities should be “logging” in their controlled substances upon receipt of medications from the pharmacy?

    • Eric Christianson

      I typically recommend a signed receipt from the delivery person to ensure that what is actually received is correct. Ideally, those controlled substances should be logged in ASAP with two staff signing them in from the start to help ensure the accuracy from the beginning.


Submit a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Written By Eric Christianson

May 7, 2014

Study Materials For Pharmacists


Explore Categories