Drug Diversion in Long Term Care – Case Examples

As a consultant pharmacist, I have encountered numerous scenarios of drug diversion in long term care and assisted living settings. I have a deep appreciation for the safe and appropriate use of medications and tracking and monitoring of controlled substances is an essential component to ensure the safety of our residents

In the video below, I talk about two essential principles in controlled substance accountability.  The first principle outlined in the video is limited access.  Limiting the access of other staff, visitors, and non-healthcare professionals with help prevent drug diversion from happening.

The second principle of keep tabs on your controlled substances is auditing.  Auditing, sometimes referred to as counting controlled substances is a time consuming process, and there can be a fine line between good accountability and overkill.  Managing this line effectively can help prevent drug diversion and keep staff from going crazy.  In the video, I outline a mistake that I’ve frequently seen staff make when it comes to controlled substance accountability and preventing drug diversion in long term care settings.

I don’t care what setting of healthcare you are in, if you (and your facility) can master these two principles, you’ll be on your way to having a good work environment that hopefully reduces your chance of drug diversion and/or increases your opportunity to catch discrepancies quickly before they get out of hand!  If you are a pharmacist and looking for more details on the ins and outs of LTC consulting, please check out the 10+ hour master course I created!

If you are interested or have more questions about long term care and drug diversion, please feel free to shoot me an email!


  1. Jaclyn Nardi

    What would be an appropriate audit for prevention if we had a drug diversion where a nurse was signing out and pocketing “scheduled” controlled substances and she was only a PT nurse so not here but 3 days a week?

    • Eric Christianson

      That’s definitely a tricky one to investigate. Many times you may be able to assess the resident and if there is any unusual distress noted (i.e. they didn’t get their dose). That may be an indicator that this is happening. There are changes in medication therapy that can be made and you may have to discuss it with legal to see what can be done as well if there is suspicion. Without much information to go off of, I would definitely start by discussing the details of the situation with your consultant pharmacist and medical director to decide if further action seems appropriate.


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Written By Eric Christianson

April 11, 2018

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