Regularly reviewing your controlled substance inventory in your clinic and/or hospital is an important practice to prevent drug diversion. Even with automated dispensing machines (ADMs) in place, diversion can and does occur.

Approximately 10% of people in the US have some type of substance abuse problem, including prescription drugs. Healthcare professionals are not exempt from substance abuse, and compounding the situation is that many healthcare professionals have easy access to controlled substances.

In addition to compromising patient care, drug diversion comes at a financial cost to the facility.

Suggestions to prevent diversion:

  1. Have established policies and procedures in place for all areas that house controlled substances.
  2. Provide staff education on policies and procedures.
  3. For hospitals, develop a process for handling controlled substances patients may bring in from home.
  4. Inventory
  5. Routine controlled substance inventories.
  6. Random, unannounced inventories checks.
  7. Verify controlled substance dispensing matches documented administration.
  8. Clinic—two persons to check in received controlled substance inventory.
  9. In the Pharmacy
  10. Documentation of all movement of controlled substances in and out of the pharmacy.
  11. When receiving controlled substances from your wholesaler, use a two-person check-in.
  12. Utilize analytics of your ADM to understand your norms and see when a device falls outside parameters.
  13. Override reports.
  14. Duplicate removal of controlled substances.
  15. Removal of controlled substances against a discharge patient account.
  16. Canceled transactions.
  17. Controlled substance waste should be secured. Partially filled syringes/vials in unsecured sharps containers and pharmaceutical waste containers are a prime source for diversion.
  18. Secured infusion pumps for controlled substance infusions (PCA, Epidural, etc.).

Need help developing a diversion plan for your hospital or clinic? PHV can help. Contact Therese Caliendo at 402-742-2207 or for more information.


Cidambi MD, Indra. (2018, March).  Nurses Addicted to Drugs. Retrieved from:

(2016, March) Retrieved from:

Pharmacy Times. (2016, March). 10 Ways to Prevent Drug Diversion.  Retrieved from:

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